Dr. Pagel on the Importance of Screening for Double- and Triple-Hit DLBCL

John M. Pagel, MD, PhD, chief of the Hematologic Malignancies Program, and director, Hematopoietic Cell Transplantation Program, at Swedish Cancer Institute, discusses the importance of screening patients for double-hit and triple-hit diffuse large B-cell lymphoma (DLBCL).

Some patients with DLBCL have a poor prognosis due to genetic risk, Pagel says. Moreover, patients with double- or triple-hit DLBCL could have particularly aggressive disease.

As such, screening patients with DLBCL for these subtypes using fluorescence in situ hybridization is important as it can identify genetic rearrangements between the MYC gene, BCL-2, or BCL-6, explains Pagel.

Patients who have such rearrangements may be candidates for dose-adjusted rituximab (Rituxan) with EPOCH chemoimmunotherapy, Pagel says.

Patients who do not have those rearrangements but overexpress those genes as determined by immunohistochemistry and cytochemistry are considered intermediate risk and may be better suited for standard R-CHOP therapy, concludes Pagel.