Serplulimab, Chidamide, and Rituximab Followed by Sequential R-CHOP for Newly Diagnosed Elderly MYC/BCL2 Double-Expressor DLBCL

Exclusion criteria

• . Primary central nervous system (CNS) lymphoma or secondary CNS involvement.
• . Primary mediastinal (thymic) large B-cell lymphoma, primary effusion DLBCL, unclassifiable B-cell lymphoma with features intermediate between DLBCL and classical Hodgkin lymphoma (grey zone lymphoma), primary cutaneous DLBCL, leg type, intravascular large B-cell lymphoma, ALK-positive large B-cell lymphoma, plasmablastic lymphoma, HHV8-positive DLBCL.
• . Transformed lymphoma, i.e., transformed from other types of lymphoma such as follicular lymphoma, marginal zone B-cell lymphoma, or chronic lymphocytic leukemia/small lymphocytic lymphoma.
• . History of severe hypersensitivity or anaphylactic reactions to humanized or murine monoclonal antibodies.
• . Presence of an active autoimmune disease that has required systemic treatment within the past two years. Replacement therapy (e.g., thyroxine for hypothyroidism, insulin for type I diabetes mellitus, or physiologic corticosteroid replacement for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed. Patients with autoimmune diseases that did not require systemic treatment in the past two years may be enrolled.
• . Systemic corticosteroid therapy (\>10 mg/day prednisone or equivalent) or other immunosuppressive therapy within 14 days prior to the start of study treatment. The use of topical, ocular, intra-articular, intranasal, or inhaled corticosteroids (with minimal systemic absorption) is permitted. Short-term (≤7 days) prophylactic use of corticosteroids (e.g., for contrast allergy) or for treatment of non-autoimmune conditions (e.g., delayed-type hypersensitivity reaction caused by contact allergen) is permitted. An exception may be made for patients requiring corticosteroids for symptom control due to high tumor burden (prednisone up to 100mg/day or equivalent, for a maximum of 7 days is permitted).
• . Diagnosis of another malignancy within the past 5 years, except for malignancies treated with curative intent, including basal cell carcinoma of the skin, squamous cell carcinoma of the skin, carcinoma in situ of the breast, or carcinoma in situ of the cervix.
• . Prior systemic anti-tumor therapy within 28 days before the start of study treatment, including chemotherapy, immunotherapy, or biologic therapy (e.g., cancer vaccines, cytokines, or growth factors targeting cancer control).