SynthesisFrontiers in oncology2026
A systematic evaluation of double-expressor lymphoma: prognostic impact, determinants of outcome, and comparative efficacy and safety of novel therapies.
Synthesis in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
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.
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