HGBL with MYC + BCL2 (and/or BCL6) rearrangements ('double-hit' / 'triple-hit') has aggre...
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
| ID | BMA-MYC-REARRANGEMENT-HGBL-DH |
|---|---|
| Type | Actionability |
| Status | reviewed 2026-04-27 | pending_clinical_signoff | actionability review required |
| Diseases | DIS-HGBL-DH |
| Sources | SRC-CIVIC SRC-ESMO-DLBCL-2024 SRC-NCCN-BCELL-2025 |
Actionability Facts
| Biomarker | BIO-DOUBLE-HIT |
|---|---|
| Variant | MYC + BCL2 (DH) or MYC + BCL2 + BCL6 (TH) |
| Disease | DIS-HGBL-DH |
| ESCAT tier | IIA |
| Recommended combinations | DA-EPOCH-R (1L preferred), pola-R-CHP (1L alternative), axi-cel / liso-cel (2L+) |
| Contraindicated monotherapy | R-CHOP alone (undercure in DH/TH per retrospective series) |
| Evidence summary | HGBL with MYC + BCL2 (and/or BCL6) rearrangements ('double-hit' / 'triple-hit') has aggressive course with R-CHOP undercure. DA- EPOCH-R (Petrich JCO 2014; Dunleavy Blood 2018) shows superior CR/PFS in single-arm series. Pola-R-CHP (POLARIX, Tilly NEJM 2022) approved for DLBCL — DH subgroup analysis numerically favorable. CAR-T (axi-cel, liso-cel) effective at 2L+. |
Notes
ESCAT IIA. CNS prophylaxis recommended. MYC-only rearrangement (single-hit) treated as DLBCL-NOS.
Used By
Actionability
BMA-BCL2-REARRANGEMENT-HGBL-DH- BCL2-R as the partner of MYC-R defines HGBL-DH. Same management as MYC-R cell: DA-EPOCH-R...