{"entity":{"id":"myc-bcl2-double-expressor","kind":"biomarker","name":"Double expressor: MYC and BCL2 protein together by immunohistochemistry","aka":["Double expressor lymphoma","DEL","MYC and BCL2 co-expression","MYC IHC","BCL2 IHC"],"tldr":"A stain showing that a lymphoma makes a lot of both the growth protein MYC and the survival protein BCL2, without the genes being rearranged. It predicts a worse course, but on its own it does not change the treatment.","summary":"Protein co-expression is several times commoner than rearrangement and is not the same thing. In a 167-patient training cohort treated with R-CHOP, MYC protein was detected in 29% and BCL2 protein in 44%, with both together in 21%; MYC protein correlated with high MYC messenger RNA and with MYC translocation, but the translocation was present in only 11%. MYC protein predicted inferior overall and progression-free survival only when BCL2 protein was present as well, and the finding held in an independent cohort of 140 patients after adjustment for other risk factors (Johnson 2012). In the 442-patient RICOVER series, MYC protein above the 40% threshold was found in 31.8% of tumours, BCL2 in 79.6% and BCL6 in 82.8% (Horn 2013).\n\nThe thresholds are not standardised across laboratories, the antibodies differ, and reading is subjective, which is the main reason this remains a prognostic observation rather than a decision point.","asOf":"2026-09-30","links":[{"label":"Johnson et al., J Clin Oncol 2012: concurrent MYC and BCL2 protein expression in diffuse large B-cell lymphoma treated with R-CHOP","url":"https://doi.org/10.1200/JCO.2011.41.0985"},{"label":"Horn et al., Blood 2013: MYC, BCL2 and BCL6 rearrangement and expression in 442 RICOVER patients","url":"https://doi.org/10.1182/blood-2012-06-435842"}],"tags":["biomarker","lymphoma"],"related":["double-hit-rearrangement","bcl2-rearrangement"],"cancers":["dlbcl","non-hodgkin-lymphoma"],"sections":[],"technologies":["histopathology-ihc"],"targets":["myc-gene","bcl2"],"drugs":[],"companies":[],"institutions":[],"pathways":["myc","apoptosis-bcl2"],"terms":["ihc","cell-of-origin"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"target":"myc-gene","measurement":"ihc-score","scoringRule":{"text":"Immunohistochemistry for MYC and BCL2 read as the percentage of tumour nuclei or cytoplasm staining, with commonly used cut-offs of 40% for MYC and 50% for BCL2; a double expressor is positive for both. The thresholds are not harmonised between laboratories and the stains are read by eye, so two centres can call the same block differently.","quote":"MYC protein expression was only associated with inferior overall and progression-free survival when BCL2 protein was coexpressed (P < .001).","source":"https://doi.org/10.1200/JCO.2011.41.0985","sourceLabel":"Johnson et al., Journal of Clinical Oncology 2012"},"thresholds":[],"definedBy":{"label":"Johnson et al., J Clin Oncol 2012: concurrent MYC and BCL2 protein expression in diffuse large B-cell lymphoma treated with R-CHOP","url":"https://doi.org/10.1200/JCO.2011.41.0985"},"tests":[],"assays":[],"companionDiagnostics":[],"forPatient":"This is a prognostic label, not a different disease. It does not by itself mean a stronger regimen, and it is not the same as a double hit, which is found by a different test and does change the plan. It is worth asking which of the two a report means, because the names are easy to confuse."},"route":"/biomarkers/myc-bcl2-double-expressor/","neighbours":{"biomarker":[{"id":"bcl2-rearrangement","kind":"biomarker","name":"BCL2 rearrangement, t(14;18)","route":"/biomarkers/bcl2-rearrangement/"},{"id":"double-hit-rearrangement","kind":"biomarker","name":"Double-hit and triple-hit: MYC with BCL2 and BCL6 rearrangement","route":"/biomarkers/double-hit-rearrangement/"}],"cancer":[{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"}],"technology":[{"id":"histopathology-ihc","kind":"technology","name":"Histopathology & immunohistochemistry","route":"/technologies/histopathology-ihc/"}],"target":[{"id":"bcl2","kind":"target","name":"BCL-2","route":"/targets/bcl2/"},{"id":"myc-gene","kind":"target","name":"MYC","route":"/targets/myc-gene/"}],"pathway":[{"id":"apoptosis-bcl2","kind":"pathway","name":"Intrinsic apoptosis (BCL-2 family)","route":"/pathways/apoptosis-bcl2/"},{"id":"myc","kind":"pathway","name":"MYC","route":"/pathways/myc/"}],"term":[{"id":"cell-of-origin","kind":"term","name":"Cell of origin (GCB vs ABC)","route":"/terms/cell-of-origin/"},{"id":"ihc","kind":"term","name":"Immunohistochemistry (IHC)","route":"/terms/ihc/"}]}}