Participants in the R-CHOP group with either double-hit lymphoma (n=18) or dual high expression of MYC and BCL-2 mRNA (ie, double-expressor lymphoma; n=102) had significantly worse progression-free survival at 30 months than participants in the same treatment group without these rearrangements (double-hit lymphoma in the R-CHOP group: 38·9% vs 75·8%, adjusted HR 3·07, 95% CI 1·64–5·76; p=0·00048; and dual-expressor lymphoma in the R-CHOP group: 61·5% vs 75·8%, adjusted HR 1·81, 1·26–2·60; p=0·0013; figure 3). The gene discussed is DDIT3; the disease is lymphoma.