Double hit (DH) are defined as MYC and BCL2 or/and BCL6 coexpressing B-cell lymphomas. Morphologically they are found in the diffuse large B-cell lymphoma (DLBCL) or in the group of B-cell lymphoma, unclassifiable, with features between DLBCL and Burkitt lymphoma (BCLU). Approximately 5–10 % of DLBCLs and BCLUs are DH lymphomas according to fluorescence in situ hybridization, the percentage rises to 30 %, if protein overexpression is detected by immunohistochemistry. Treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone seems to be insufficient. However, for more intensive regimens and/or high-dose therapy with stem cell rescue conflicting results exist. Clinical trials with novel therapies are urgently needed.