Double-Hit Lymphoma: Practicing in a Data-Limited Setting

In the article that accompanies this commentary, Staton and Cohen1 present a rational approach to the care of patients with double-hit lymphoma (DHL). The major issues faced in the care of these patients—use of intensive induction regimens, CNS prophylaxis, and transplantation—are all well addressed within the authors’ therapeutic recommendations, which are based on an interpretation of the existing literature. However, the state of the existing literature makes it challenging to propose recommendations for the treatment of DHL and the more common double-expressing lymphoma (DEL). The literature is nearly wholly derived from retrospective studies that are often from single centers. Unlike the broader entity of diffuse large B-cell lymphoma (DLBCL), for which randomized studies have been conducted to determine the optimal treatment regimen, we have virtually no prospective data on which to base treatment recommendations.