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Lymphomas

Double-hit lymphoma (MYC and BCL2 rearranged)

Also called Diffuse large B-cell lymphoma/high-grade B-cell lymphoma with MYC and BCL2 rearrangements

If you or someone you love has just heard this diagnosis, start here. This guide explains what the condition is, how it is usually treated and where a transplant fits.

Double-hit lymphoma is a fast-growing B-cell lymphoma in which two genes, MYC and BCL2, have been rearranged. It is usually treated first with strong chemotherapy combined with an antibody medicine. If it does not respond or comes back, CAR-T cell therapy or a transplant using the person’s own stem cells may be options.

Written and source-checked by the Jada Bascom FoundationSources checked Editorial standards

In-depth guide
Other names and abbreviations

DLBCL/HGBL-MYC/BCL2, HGBL-DH, HGBL-DH/TH, HGBCL-DH-BCL2, DHL, THL, double hit lymphoma, triple hit lymphoma, High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (WHO revised 4th edition name), double-hit lymphoma, triple-hit lymphoma

In short

  • Double-hit lymphoma is a fast-growing B-cell lymphoma. A lab test on the biopsy shows that two genes, MYC and BCL2, are rearranged.
  • First treatment is usually chemotherapy with an antibody medicine, often a more intensive mix. Joining a clinical trial is worth asking about.
  • If it does not respond or comes back, CAR-T cell therapy or a transplant with the person’s own stem cells may be used. A donor transplant is an option for some people later on.
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Underlined words open a short explanation. See all terms

Where transplant fits

European guidance does not make a routine part of first treatment, though some UK teams may offer an own-cell transplant after a good first response. U.S. guidelines (ASTCT, 2023) say one may be considered after a full on R-CHOP-type treatment, but not after more intensive first treatment. If the lymphoma does not respond or returns within about a year, made from the person’s own is the European standard for eligible people; later that respond may be treated with and the person’s own . A is a selected option after CAR-T or an own-cell transplant fails.

Treatment depends on the exact diagnosis, disease stage, prior treatment and the person’s health.

Key facts

Who it affects
Double-hit lymphoma tends to develop in older adults, usually over 60. Some cases grow out of an earlier follicular lymphoma.
How common
About 7 to 9 in 100 large B-cell lymphomas testedAdults aged 75 or younger with DLBCL-type lymphoma and FISH results, British Columbia, Canada: 38 of 572 diagnosed 2005–2010 and 66 of 693 diagnosed 2015–2020 Source: How common
Cells used in a transplant
The person’s own collected stem cells for an autologous transplant, and their own T cells for CAR-T. Donated blood-forming cells are used only if an allogeneic transplant is chosen.
Where a donor fits
Cell or gene therapy options

The condition

What it is

Lymphoma is a cancer of lymphocytes, white blood cells that help fight infection. Double-hit lymphoma is an aggressive lymphoma of , the lymphocytes that make . Under the microscope it often looks like diffuse large B-cell lymphoma (DLBCL), though in some cases the cells are medium-sized or look more like other fast-growing lymphomas.

What sets it apart is a test result, not the look of the cells. In a lab test called FISH, two genes, MYC and BCL2, are found broken and rejoined to other DNA. This is called a rearrangement. The World Health Organization now names this condition “diffuse large B-cell lymphoma/high-grade B-cell lymphoma with MYC and BCL2 rearrangements.”

A few related terms cause confusion. “Double-expressor” lymphoma means the MYC and BCL2 proteins are high, but the genes are not rearranged; that is a different finding. Lymphomas with rearranged MYC and BCL6, but not BCL2, are no longer grouped here. “Triple-hit” lymphoma, with all three genes rearranged, still has the MYC and BCL2 rearrangements that define this group.

Where double-hit lymphoma (MYC and BCL2 rearranged) starts in the bloodDouble-hit lymphoma is an aggressive cancer of mature B cells in which the MYC and BCL2 genes have both been rearranged.Simplified illustration.

Marked as affected: B cells.

  • Blood stem cell, In the bone marrow
    • Myeloid line
      • Red blood cells
      • Platelets
      • Granulocytes
      • Monocytes
    • Lymphoid line
      • B cells, Affected
        • Plasma cells, Develop from B cells
      • T cells
      • NK cells, Natural killer cells

What causes it

MYC and BCL2 normally help control how B cells grow. When both are rearranged in the same B cell, that control is lost and the lymphoma can grow quickly. These changes happen in the lymphoma cells during a person’s life.

They are not inherited from a parent and are not passed to children. The lymphoma is not contagious. Some cases grow out of an earlier, slower lymphoma called follicular lymphoma, while others appear without one.

Symptoms and effects

People often notice swollen lymph nodes, sometimes in many places. Fevers, night sweats and weight loss are common. The lymphoma often starts outside the lymph nodes and is usually at an advanced stage by the time it is found.

It often reaches the , and it can spread to the brain and spinal cord. That is why doctors may do extra tests and discuss whether treatment to lower that risk makes sense. A recent population-based study found this spread was less common than older reports suggested.

Diagnosis and treatment

How double-hit lymphoma is diagnosed

Double-hit lymphoma is found with a lab test on the biopsy, not by how the cells look. A doctor removes tissue, usually from a swollen lymph node. The lab then runs FISH, a test that uses glowing dyes that stick to specific genes. It shows whether MYC and BCL2 are broken and rejoined to other DNA (rearranged). BCL6 is often checked too.

Labs differ in which biopsies they test. From 2018, British Columbia, Canada, tested every large B-cell lymphoma biopsy for MYC, then checked BCL2 and BCL6 if MYC was rearranged. It made that change after a study showed that choosing cases by protein stains could miss up to a quarter of double-hit lymphomas. FISH can also miss some rearrangements that are hidden from its probes.

Staging tests show how far the lymphoma has spread. These often include a PET-CT scan, blood tests including LDH, and a bone marrow biopsy. Because this lymphoma can reach the brain and spinal cord, a spinal tap (lumbar puncture) may be done.

Treatment sometimes has to start before the FISH result is back. In British Columbia, people in that situation got one cycle of standard R-CHOP. Once double-hit lymphoma was confirmed, they moved to a stronger regimen if suitable.

How it is treated

There is no single standard first treatment. Many doctors use more intensive chemotherapy combined with rituximab, an antibody medicine, because studies suggest the usual regimen called R-CHOP works less well here. Those studies were not randomized , so the best approach is still not settled, and a clinical trial is often worth asking about. The US National Cancer Institute also notes a clear benefit from a newer regimen called Pola-R-CHP in double-hit lymphoma.

If the lymphoma does not respond to first treatment or comes back within about a year, CAR-T cell therapy is now a standard option for people who are well enough. CAR-T uses the person’s own T cells, collected from their blood and changed in a lab to attack lymphoma. European transplant experts include double-hit lymphoma with the other large B-cell lymphomas in this advice.

If the lymphoma comes back later and responds to more chemotherapy, high-dose chemotherapy followed by a transplant of the person’s own stem cells is an option. European transplant guidance does not recommend that kind of transplant as a routine part of first treatment, although some UK teams may offer it after a good first response. U.S. transplant guidelines (ASTCT, 2023) say it may be considered for eligible people in full remission after R-CHOP or a similar regimen, but not after more intensive first treatment. A donor (allogeneic) transplant is considered only in selected people, usually after CAR-T or an own-cell transplant has not worked.

How double-hit lymphoma (MYC and BCL2 rearranged) can be treatedFirst treatment is usually chemotherapy with an antibody medicine, and CAR-T cell therapy or a transplant may be used if the lymphoma returns.Simplified illustration.

Kinds of treatment described for double-hit lymphoma (MYC and BCL2 rearranged): medicines, a donor stem cell transplant (for some people), a transplant with the person’s own cells (for some people), CAR T-cell therapy and clinical trials.

After diagnosis, the options described here

  • Medicines

    First treatment is usually chemotherapy with an antibody medicine, often a more intensive mix.

  • Donor stem cell transplant, For some people

    A donor transplant is an option for some people later on, usually after CAR-T or an own-cell transplant has not worked.

    What a transplant involves

  • Transplant with the person’s own cells, For some people

    If the lymphoma comes back later and responds to more chemotherapy, a transplant with the person’s own stem cells is an option.

    What a transplant involves

  • CAR T-cell therapy

    If the lymphoma does not respond or comes back within about a year, CAR-T cell therapy is a standard option for people well enough.

  • Clinical trials

    The best first treatment is still not settled, so a clinical trial is often an option.

These are the kinds of treatment this page describes, not a plan. Which ones fit, in what order and whether they are combined differs from person to person.

When transplant specialists are usually consulted

NMDP and ASTCT guidance for U.S. care teams lists double-hit or triple-hit lymphoma as a reason for a transplant consultation at diagnosis. For high-grade B-cell lymphoma with these gene changes, it also lists first remission, no response to first treatment, first relapse, and a second or later remission.

Read the guidance

What a transplant involves

What a transplant with your own cells involvesTiming and details differ by person and transplant center.Simplified illustration.
  1. Step 1

    : Collecting the person’s own cells

    Medicines move stem cells out of the marrow and into the blood. The cells are then collected and frozen.

  2. Step 2

    : High-dose treatment

    The person receives strong treatment, usually high-dose chemotherapy.

  3. Step 3

    : Cells returned, Day 0

    The stored cells are thawed and given back through a vein, like a transfusion.

  4. Step 4

    : Blood counts recover

    The returned cells settle in the marrow and start making blood cells again.

  5. Step 5

    : Follow-up

    The care team keeps checking recovery and watches for infection and for the condition coming back.

A transplant, step by step

Daily life and the donor’s role

Living with the condition and treatment

Treatment usually has to start quickly, and intensive chemotherapy can mean hospital stays of several weeks. Tiredness, a higher risk of infection and other side effects depend on the regimen. A fever during treatment needs a call to the care team straight away.

CAR-T is given at specialist centers. The team watches closely for cytokine release syndrome, a strong immune reaction that can cause high fevers, and for confusion or other nerve-system effects. A transplant with a person’s own cells means collecting stem cells first, then high-dose treatment and several weeks of recovery while blood counts return.

The role of a blood stem cell donor

Most treatment for double-hit lymphoma does not use a donor. A transplant with a person’s own stem cells uses their own blood-forming cells. Approved CAR-T treatments also start with the person’s own cells, but these are T cells changed to fight lymphoma, not a new marrow.

A registry donor is needed only if a donor (allogeneic) transplant is chosen, which European experts list as an option for eligible people after CAR-T or an own-cell transplant has not worked. Then a brother or sister, an unrelated volunteer or a relative may be considered. Registry volunteers help patients with many conditions, including people with this lymphoma who do need a donor.

Where transplant cells come fromWhich source a team considers depends on the condition, the person and who is available.Simplified illustration.

Highlighted here: the person’s own cells.

  • The person’s own cells

    Autologous transplant, no donor

    Collected from the person before treatment, then given back.

  • A relative

    Donor transplant (allogeneic)

    A brother or sister may be a full match. Parents and children can be half-matched donors.

  • An unrelated volunteer

    Donor transplant (allogeneic)

    Found through a donor registry.

  • Donated cord blood

    Donor transplant (allogeneic)

    Collected from a baby’s umbilical cord after birth and stored in a public bank.

Looking ahead

Looking ahead

Outlook for double-hit lymphoma

Double-hit lymphoma has a poorer outlook than most large B-cell lymphomas, but many people do reach a lasting remission. Age, fitness and other health problems shape which treatments are possible.

Results have improved as testing and treatment changed. In 2015, British Columbia, Canada, began recommending more intensive chemotherapy (DA-EPOCH-R) for fit people aged 75 or younger. Two-year survival rose from 47% for people diagnosed in 2005–2010 to 75% for those diagnosed in 2015–2020. People whose double-hit lymphoma grew out of a follicular lymphoma already treated with chemotherapy and antibody medicine did poorly. Those whose follicular lymphoma had not been treated that way did about as well as others.

If the lymphoma does not respond or comes back within a year, the outlook is more guarded. CAR-T cell therapy is then the usual next step for eligible people, as for other large B-cell lymphomas.

About these numbers. Each one says which group of people it comes from, and the place and years where the source gives them. It describes what happened across that group, not what will happen to any one person. And a figure measured among people who had a transplant is not the same as the number of people who need one.

  • 75%Alive 2 years after diagnosis

    66 adults aged 75 or younger with double-hit lymphoma (MYC and BCL2 rearranged, DLBCL appearance, not grown out of an earlier lymphoma), British Columbia, Canada, diagnosed 2015–2020; 47 of the 66 received intensive DA-EPOCH-R

    Read the source: Alive 2 years after diagnosis
  • 47%Alive 2 years after diagnosis, earlier era

    38 adults aged 75 or younger with the same lymphoma, found by research testing of all biopsies, British Columbia, Canada, diagnosed 2005–2010; 32 of the 38 received standard R-CHOP

    Read the source: Alive 2 years after diagnosis, earlier era

These figures come from one Canadian province and from people aged 75 or younger. They cannot predict how any one person will do.

Common questions

What is double-hit lymphoma?

Double-hit lymphoma is a fast-growing B-cell lymphoma in which two genes, MYC and BCL2, are rearranged, meaning broken and joined to other DNA. These genes normally help control how B cells grow. Most cases look like diffuse large B-cell lymphoma, and some look more like Burkitt lymphoma. The World Health Organization calls it diffuse large B-cell lymphoma/high-grade B-cell lymphoma with MYC and BCL2 rearrangements.

What is the difference between double-hit and double-expressor lymphoma?

Double-hit lymphoma means the MYC and BCL2 genes themselves are rearranged, which a lab test on the biopsy shows. Double-expressor lymphoma means the cells make high levels of the MYC and BCL2 proteins, but the genes are not rearranged. The National Cancer Institute says both findings are linked to a poorer outlook. In one study of people with returning lymphoma who had an own-cell transplant, double-hit lymphoma did worse than double-expressor lymphoma.

Is double-hit lymphoma curable?

Some people reach a lasting remission, but it is a hard lymphoma to treat. In a study at 19 US academic centers of 159 adults diagnosed from 2006 to 2015 whose double-hit lymphoma went fully into remission after first treatment, 80% were still free of it 3 years later. When it comes back, long-term survival is rare. For lymphoma that returns or does not respond, CAR-T cell therapy has worked well for many people in this group.

How is double-hit lymphoma treated?

There is no single standard treatment. Studies suggest the usual R-CHOP chemotherapy works less well, so many teams use more intensive chemotherapy, though randomized trials have not confirmed this. The National Cancer Institute notes a clear benefit from a newer regimen, Pola-R-CHP, for some people with double-hit lymphoma. Treatment can mean several weeks in the hospital, and a clinical trial is worth asking about.

Does double-hit lymphoma need a bone marrow transplant?

Not usually as part of first treatment. European transplant experts (EBMT) call an own-cell transplant after first treatment questionable and not routine, and a US study found it was not linked to better 3-year results for people already in full remission. U.S. transplant guidelines (ASTCT, 2023) say it may be considered after a full remission on R-CHOP or a similar regimen, but not after more intensive first treatment. Some UK teams may still offer one. If the lymphoma does not respond or comes back early, CAR-T made from the person’s own T cells is the European standard for eligible people. Donor transplants are for selected people.

Why the details matter

The classification changed in 2022: lymphomas with MYC and BCL6 rearrangements but not BCL2 are no longer counted, so older studies mixed groups. The best first treatment has not been settled by randomized trials. European and UK sources differ on an own-cell transplant after first treatment, and transplant guidance groups double-hit lymphoma with other large B-cell lymphomas.

How a transplant using your own cells works

For your next appointment

Double-hit lymphoma (MYC and BCL2 rearranged)

From the Jada Bascom Foundation disease library, jadabascomfoundation.org. Printed .

Questions to bring to your care team

  • Was FISH done for MYC, BCL2 and BCL6 on my biopsy, and was the result clear?
  • Did this lymphoma grow out of an earlier follicular lymphoma, and does that change the plan?
  • Do I need a spinal tap, or treatment to lower the risk of spread to the brain and spinal cord?
  • Should we meet a transplant and CAR-T team now, in case the first treatment does not work?
  • What is the exact name of the diagnosis or subtype, and what does it mean for treatment?
  • What is the goal of each treatment you are suggesting?
  • If a transplant is suggested, will it use the patient’s own cells? What happens before and after?
  • Where can our family find support during treatment?

A one-page list to take to the next appointment, with room for notes.

Supporting someone with a diagnosis

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Support for patients and families

These independent organizations offer information and support. JBF is not affiliated with them.

Sources and further reading

  1. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms
    WHO classification authors / Leukemia, 2022-06-22; accessed 2026-09-24
  2. Aggressive B-Cell Non-Hodgkin Lymphoma Treatment (PDQ): Health Professional Version
    NCI (PDQ, health professional version), Updated 2025-05-12; accessed 2026-09-24
  3. Indications for haematopoietic cell transplantation and CAR-T for haematological diseases, solid tumours and immune disorders: 2025 EBMT practice recommendations
    EBMT / Bone Marrow Transplantation, 2025-09-09; accessed 2026-09-24
  4. Double-hit lymphoma: optimizing therapy
    ASH Education Program (via PubMed), 2021-12-10
  5. CNS relapse in high-grade B-cell lymphoma with MYC and BCL2 rearrangements and dark-zone signature-expressing DLBCL
    Blood (via PubMed), 2025-02-06
  6. Grey zone lymphoma, double-hit lymphoma, triple-hit lymphoma, and high-grade B-cell lymphomas, not otherwise specified (NOS)
    Lymphoma Action (UK charity), Last reviewed August 2026; accessed 2026-09-24
  7. ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Diffuse Large B Cell Lymphoma
    ASTCT / Transplantation and Cellular Therapy (via PubMed), 2023-09; accessed 2026-09-26
  8. Outcomes of Patients With Double-Hit Lymphoma Who Achieve First Complete Remission
    Journal of Clinical Oncology (Landsburg et al., via PubMed), 2017-07; accessed 2026-09-24
  9. Population-wide introduction of dose-adjusted EPOCH-R in high-grade B-cell lymphoma with MYC/BCL2 rearrangements, DLBCL morphology
    Blood Advances (Alduaij et al., BC Cancer; via PMC), 2026-01; accessed 2026-09-26
  10. Tests for Non-Hodgkin Lymphoma
    American Cancer Society, Last revised 2024-02-15; accessed 2026-09-26
  11. HCT consultation timing guidelines: Non-Hodgkin lymphoma (NHL)
    NMDP / ASTCT, Accessed 2026-09-26

This information explains a condition and its treatments. It cannot diagnose an illness or recommend treatment for an individual. Your care team can explain how the evidence applies to you. Written and source-checked by the Jada Bascom Foundation. Each page lists the published sources it draws on.

Ways to help

Other patients need a donor.

A transplant for double-hit lymphoma (MYC and BCL2 rearranged) usually uses the patient’s own cells, but thousands of other patients need a donor. For many of them, that donor is a stranger who joined a registry.

Join the registry

JBF points you to the official registry that serves your country. It explains who can join and what donation involves.

Join through NMDPFor people who live in the United StatesLive somewhere else?Find the registry where you live

Support this work

Gifts to the Jada Bascom Foundation support donor-awareness education like this page, community outreach, drive planning and referrals to official registries.

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Help a family find a donor

Our family guide explains practical ways to help someone who needs a donor. A registration drive can add many potential donors at once, for them and for others.

Read the family guide

More in the library

Keep learning

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