尽管与 R-CHOP 相比没有生存获益，但强化化学免疫治疗方案通常用于患有双重打击和三重打击淋巴瘤 (DHL/THL) 的年轻患者。关于 CODOX-M/IVAC-R 应用的有利回顾性报告存在选择偏差，因为只有年轻健康的患者才能耐受这种治疗。我们进行了一项回顾性分析，以调查 CODOX-M/IVAC-R 和 DA-EPOCH-R 在 60 岁或以下 DHL/THL 患者中的结果差异。确诊113名患者； CODOX-M/IVAC-R (N=49) 和 DA-EPOCH-R (N=64)。 80% (39/49) 的人在完成 CODOX-M/IVAC-R 后达到完全 (CR)，而使用 DA-EPOCH-R 的比例为 58% (37/64)。 CODOX-M/IVAC-R 组和 DA-EPOCH-R 组的中位随访时间分别为 5.3 年和 3.3 年。 CODOX-M/IVAC-R 在单变量（HR=0.54，95%CI=0.31-0.97）和根据年龄、BCL 易位（BCL2 与 BCL6 与两者）、IPI 评分和接受 ASCT（aHR）进行调整的多变量分析中表现出优异的 EFS =0.52，95%CI=0.29-0.93)；然而，对 OS 没有显着影响（aHR=0.92，95%CI=0.46-1.84）。 CODOX-M/IVAC-R 组的 1 年、2 年和 5 年 EFS 分别为 68.3%、64.1% 和 61.5%，而 DA-EPOCH-R 组分别为 52.4%、48.9% 和 39.5%。 33% (16/49) 的 CODOX-M/IVAC-R 和 54% (35/64) 的 DA-EPOCH-R 受者发生原发性难治性疾病或复发，中位 OS 分别为 10.3 个月和 33.7 个月，表明患有 R/R 疾病的 CODOX-M/IVAC-R 亚组结果不佳。 DA-EPOCH-R 组中有更多患者能够接受后续挽救治疗。没有患者死于治疗方案毒性，两组的中枢神经系统复发率和治疗相关的血液肿瘤发生率相似。

Intensified chemoimmunotherapy regimens are often used in young patients with double hit and triple hit lymphoma (DHL/THL) despite no survival benefit compared to R-CHOP. Favorable retrospective reports on the application of CODOX-M/IVAC-R are subject to selection bias as only young fit patients can tolerate this treatment. We conducted a retrospective analysis to investigate outcome differences between CODOX-M/IVAC-R and DA-EPOCH-R in DHL/THL patients aged 60 years or younger. 113 patients were identified; CODOX-M/IVAC-R (N=49) and DA-EPOCH-R (N=64). 80% (39/49) achieved complete (CR) after completing CODOX-M/IVAC-R compared to 58% (37/64) with DA-EPOCH-R. The median follow-up was 5.3 years and 3.3 years for the CODOX-M/IVAC-R and DA-EPOCH-R group respectively. CODOX-M/IVAC-R demonstrated superior EFS on univariate (HR=0.54, 95%CI=0.31-0.97) and multivariable analysis adjusted for age, BCL translocation (BCL2 vs BCL6 vs both), IPI score and receipt of ASCT (aHR=0.52, 95%CI=0.29-0.93); however there was no significant influence on OS (aHR=0.92, 95%CI=0.46-1.84). The 1, 2 and 5 years EFS in the CODOX-M/IVAC-R group was 68.3%, 64.1% and 61.5% respectively compared to 52.4%, 48.9% and 39.5% respectively in the DA-EPOCH-R group. Primary refractory disease or relapse occurred in 33% (16/49) of CODOX-M/IVAC-R and 54% (35/64) of DA-EPOCH-R recipients, and produced median OS of 10.3 months and 33.7 months, respectively, indicating poor outcomes in the CODOX-M/IVAC-R subgroup with R/R disease. More patients were able to receive subsequent salvage therapies in the DA-EPOCH-R group. No patients died of regimen toxicity and the rates of CNS relapse and therapy related hematologic neoplasms were similar in both groups.