{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:48:19Z","timestamp":1782197299071,"version":"3.54.5"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82260042"],"award-info":[{"award-number":["82260042"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012547","name":"Natural Science Foundation of Guangxi Zhuang Autonomous Region","doi-asserted-by":"publisher","award":["2018GXNSFBA281026, 2024GXNSFAA010016"],"award-info":[{"award-number":["2018GXNSFBA281026, 2024GXNSFAA010016"]}],"id":[{"id":"10.13039\/100012547","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Double-expressor lymphoma (DEL), characterized by concurrent overexpression of MYC and BCL2 without gene rearrangements, represents 20%\u201330% of DLBCL and confers inferior outcomes with standard R-CHOP. However, no head-to-head trials comparing novel R-CHOP-based regimens specifically in DEL exist. We conducted a frequentist network meta-analysis to compare four modified R-CHOP regimens in treatment-na\u00efve DEL patients. PubMed, EMBASE, Cochrane Library, and Web of Science were searched through December 2025. The efficacy analysis included four studies (CAVALLI, DEB, POLARIX, Randomised Evaluation of Molecular guided therapy for Diffuse Large B-cell lymphoma with Bortezomib (REMoDL-B); 1,016 DEL patients) evaluating Pola-R-CHP, Ven-R-CHOP, VR-CHOP, and CR-CHOP versus R-CHOP in a star-shaped network in which all interexperimental comparisons are purely indirect through the common R-CHOP comparator. For progression-free survival (PFS), Pola-R-CHP was the only regimen achieving statistical significance (HR\u00a0=\u00a00.65, 95% CI\u00a0=\u00a00.45\u20130.94; SUCRA\u00a0=\u00a076.1%), reducing progression risk by 35%. A supplementary Bayesian analysis confirmed this finding (posterior probability of HR &amp;lt; 1: 90.2%). No regimen significantly improved overall survival (OS). CR-CHOP showed the most favorable OS trend (HR\u00a0=\u00a00.77, 95% CI\u00a0=\u00a00.53\u20131.13; SUCRA\u00a0=\u00a069.8%). Safety analysis from intention-to-treat populations revealed that Ven-R-CHOP significantly increased grade 3\u20134 thrombocytopenia (OR\u00a0=\u00a017.24), neutropenia (OR\u00a0=\u00a03.42), and anemia (OR\u00a0=\u00a03.29), whereas Pola-R-CHP demonstrated a safety profile comparable to R-CHOP (any grade 3\u20134 AE: OR\u00a0=\u00a01.04). Sensitivity analyses excluding CAVALLI (historical control design), using alternative DEL definitions for REMoDL-B, and excluding REMoDL-B confirmed robustness. Pola-R-CHP may offer a favorable benefit\u2013risk profile in DEL; however, this is based on indirect, subgroup-level evidence of moderate-to-low certainty, and prospective DEL-specific trials are needed for confirmation. The study protocol was registered on INPLASY (registration number: INPLASY202630036; DOI:\n                    <jats:ext-link>10.37766\/inplasy2026.3.0036<\/jats:ext-link>\n                    ).\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1832980","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:18:33Z","timestamp":1782195513000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Network meta-analysis of first-line R-CHOP-based regimens in MYC\/BCL2 double-expressor diffuse large B-cell lymphoma"],"prefix":"10.3389","volume":"17","author":[{"given":"Hao","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Hematology\/Oncology, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baoping","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohong","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Cen","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengcheng","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Guangxi Medical University Cancer Hospital","place":["Nanning, Guangxi, China"]},{"name":"State Key Laboratory of Targeting Oncology, Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2025.108117","article-title":"Real-world treatment patterns and clinical outcomes of patients with treatment-na\u00efve and relapsed\/refractory diffuse large B-cell lymphoma in the United States","volume":"159","author":"Lue","year":"2025","journal-title":"Leuk Res"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011795","article-title":"CHOP chemotherapy plus rituximab compared with CHOP 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