• All patients with aggressive non Hodgkin lymphoma should be evaluated for MYC and BCL2/6 gene expression, if possible, by fluorescent in situ hybridization and immunohistochemistry.
• Several intensive treatment regimens are available. Dr. Cohen favors dose-adjusted R-EPOCH for patients with double-hit lymphomas and for those classified as “double expressors.”
• All patients should be assessed for central nervous system disease with strong consideration for prophylaxis.
• Auto transplant’s role has not been established. Dr. Cohen recommends the pros and cons of stem cell transplant be discussed with each patient. ■