Double hit lymphoma

•  Less than 10% of lymphoma are DH or TH
• Ideally, all high-grade lymphomas should be tested for double and triple hit, definitely all GCB types
• Chromosome 2 ( kappa light chain), 
• chromosome 3 ( BCL6)
• Chromosome 8 ( c-myc), 
• Chr 14( heavy chain IGH), 
• chr 18 ( BCL-2), 
• chr 22 ( lambda)
• In addition to usual lymphoma testing, viral and cardiac tests, also do LP and CSF cytology in double hit
• If CSF positive or CNS symptoms--> get MRI brain
• Treatment: DA R EPOCH for denovo
• Add 4 cycles IT methotrexate
• If CSF positive, place Omaya , add systemic MTX and cytarabine with CHOP
• If CNS involvement and pt gets to CR--> auto SCT
• Frail, > 80 yr , cardiac dysfunction or cannot use anthracycline-->R-CGOP (rituximab, cyclophosphamide, gemcitabine, vincristine, and prednisone).