A salvage chemotherapy regimen sometimes used in relapsed/refractory non-Hodgkin lymphomas (NHL), especially aggressive types, in patients who are not candidates for intensive regimens (like R-ICE or R-DHAP).
Components
- R = Rituximab (anti-CD20 monoclonal antibody)
- C = Cyclophosphamide (alkylating agent)
- E = Etoposide (topoisomerase II inhibitor)
- P = Procarbazine (alkylating agent)
- P = Prednisone (corticosteroid)
Typical Dosing (q21 days, varies by protocol)
- Rituximab: 375 mg/m² IV Day 1
- Cyclophosphamide: 600 mg/m² IV Day 1
- Etoposide: 70 mg/m² IV Days 1–3
- Procarbazine: 100 mg/m² PO Days 1–7
- Prednisone: 60 mg/m² PO Days 1–14
(Exact dosing schedules may differ by institution or clinical trial protocol.)
Indications
- Relapsed/refractory aggressive B-cell lymphomas, particularly when anthracyclines (like doxorubicin) are contraindicated due to cardiac comorbidity.
- Useful in patients who need a less intensive salvage regimen compared to R-ICE, R-DHAP, or R-GDP.
Toxicities / Monitoring
- Rituximab: Infusion reactions, hepatitis B reactivation → screen before therapy.
- Cyclophosphamide: Myelosuppression, hemorrhagic cystitis (hydration important).
- Etoposide: Myelosuppression, alopecia, mucositis, rare secondary AML.
- Procarbazine: Myelosuppression, nausea, secondary malignancies, avoid tyramine-containing foods (MAOI-like effect).
- Prednisone: Hyperglycemia, mood changes, immunosuppression, osteoporosis.
Monitoring: CBC, renal/hepatic function, infection signs, hepatitis B panel, dietary counseling (procarbazine).
Key Clinical Point