R-ICE is a salvage chemotherapy regimen used in relapsed or refractory aggressive B-cell lymphomas, including diffuse large B-cell lymphoma (DLBCL). It is often used prior to autologous stem cell transplant.
R-ICE Components:
| Drug | Mechanism / Role |
|---|---|
| R – Rituximab | Anti-CD20 monoclonal antibody; targets B-cells |
| I – Ifosfamide | Alkylating agent; cross-links DNA |
| C – Carboplatin | Platinum compound; DNA cross-linking agent |
| E – Etoposide | Topoisomerase II inhibitor; causes DNA strand breaks |
Typical Dosing (Every 14 or 21 days):
- Rituximab: 375 mg/m² IV on Day 1
- Ifosfamide: 5,000 mg/m² IV over 24 hours or divided over Days 2–4
- Given with mesna for uroprotection
- Carboplatin: AUC 5 IV on Day 2
- Etoposide: 100 mg/m² IV Days 1–3
Indications:
- Relapsed or refractory DLBCL and other aggressive B-cell lymphomas
- Often used as a bridge to high-dose chemotherapy + autologous stem cell transplant
Key Toxicities:
- Myelosuppression (especially neutropenia and thrombocytopenia)
- Nephrotoxicity and neurotoxicity (ifosfamide)
- Hemorrhagic cystitis (ifosfamide; prevent with mesna + hydration)
- Hypersensitivity/infusion reactions (rituximab)
- Nausea and vomiting (moderate to high emetogenic potential)
- Electrolyte disturbances (e.g., hypokalemia, hypomagnesemia)
Pharmacist Considerations:
- Pre-medications for rituximab (acetaminophen, antihistamine)
- Mesna for ifosfamide uroprotection
- Hydration for renal protection
- Growth factor support (G-CSF) often used due to neutropenia risk
- Monitor labs: CBC, renal function, electrolytes, and urinalysis
Synonyms
R-ICE