What question did this study set out to answer?

This research aims to evaluate the prognostic factors and treatment efficacy in double-expressor lymphoma (DEL).

May 25, 2026Open Access

A systematic evaluation of double-expressor lymphoma: prognostic impact, determinants of outcome, and comparative efficacy and safety of novel therapies

Puntos clave

This research aims to evaluate the prognostic factors and treatment efficacy in double-expressor lymphoma (DEL).
Two-stage evidence synthesis incorporating a systematic review and meta-analysis for hazard ratios.
Network meta-analysis comparing multiple treatment regimens in DEL.
Included data from 66 studies (9,808 patients) and 13 treatment studies (1,803 patients).
DEL associated with inferior progression-free survival (hazard ratio 1.78, 95% CI 1.50–2.10) and overall survival (1.90, 95% CI 1.68–2.15).
High International Prognostic Index and advanced age significantly predict inferior outcomes in DEL.
Z+R-CHOP and Ven-R-CHOP showed the highest efficacy, with Z+R-CHOP having lower hematological toxicity.

Resumen

Background Double-expressor lymphoma (DEL), defined by concurrent MYC and BCL2 protein overexpression in diffuse large B-cell lymphoma (DLBCL), is associated with poor prognosis, but precise risk quantification and optimal treatments remain unclear. Methods We conducted a two-stage evidence synthesis. First, a systematic review and meta-analysis quantified hazard ratios for progression-free survival (PFS) and overall survival (OS) comparing DEL with non-DEL and identified prognostic factors within DEL. Second, a network meta-analysis ranked the efficacy and safety of regimens including rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP); dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R); R-CHOP plus lenalidomide (R2-CHOP); R-CHOP plus ibrutinib (I+R-CHOP); R-CHOP plus zanubrutinib (Z+R-CHOP); and R-CHOP plus venetoclax (Ven-R-CHOP). Results In 66 studies (9,808 patients), DEL was significantly associated with inferior PFS (hazard ratio 1.78, 95% confidence interval 1.50–2.10) and OS (1.90, 1.68–2.15). Within DEL, high International Prognostic Index, advanced age, elevated lactate dehydrogenase, B symptoms, and advanced stage predicted inferior PFS and OS; TP53 mutation and poor Eastern Cooperative Oncology Group performance status predicted inferior OS. In 13 treatment studies (1,803 patients), Z+R-CHOP and Ven-R-CHOP showed the highest efficacy. Z+R-CHOP demonstrated favorable hematological toxicity compared with other novel regimens. Conclusion DEL is a distinct high-risk subtype with quantifiable prognostic detriment. Z+R-CHOP emerges as a promising strategy requiring validation in prospective studies.

Preguntar a la IA

Me gusta

Guardar

Ver artículo completo