RICE

Say it: RICE (like the food)

Rituximab, ifosfamide, carboplatin and etoposide

RICE is a strong combination for lymphoma that has come back or did not go away, often given to shrink the lymphoma before a stem cell transplant.

Also called: R-ICE, R ICE, ICE, RICE chemotherapy, ICE plus rituximab

What it is

These medicines work differently from the ones used in first treatment, so they can kill lymphoma cells that survived before. The usual goal is to get the lymphoma into remission so you can move on to a stem cell transplant or another treatment such as CAR T-cell therapy. Stem cells are often collected from your blood after one of the cycles.

Often used for

• B-cell lymphoma that came back or did not respond to first treatment
• treatment before a stem cell transplant
• Hodgkin lymphoma or T-cell lymphoma that came back (as ICE, without rituximab)

ICE (without rituximab)

Used for Hodgkin lymphoma and T-cell lymphoma, where rituximab does not help.

RICE with stem cell collection

After one cycle, a white blood cell booster is given and stem cells are collected from the blood to use later in a transplant.

The medicines in this plan

Rituximab

Antibody that targets a marker (CD20) on B cells. Given through a vein, usually on day 1 or just before the chemotherapy.

Ifosfamide

Chemotherapy that damages cancer cell DNA. Usually given through a vein over 24 hours on day 2.

Carboplatin

Platinum chemotherapy. Given through a vein on day 2.

Etoposide

Chemotherapy that stops cancer cells from copying their DNA. Given through a vein on days 1 to 3.

Mesna

Protects the bladder from ifosfamide. Given through a vein along with ifosfamide, and sometimes as pills afterward.

How you get it

RICE is often given in the hospital over about 3 days, though some centers give it as an outpatient. Cycles are usually every 14 to 21 days. Most people get 2 to 3 cycles before a stem cell transplant. A white blood cell booster shot is usually given after each cycle. Your schedule may be different.

A typical cycle

Day 1

Rituximab and etoposide through a vein. Some centers give rituximab a day or two before.

Day 2

Etoposide and carboplatin, then a 24 hour infusion of ifosfamide with mesna.

Day 3

Last dose of etoposide and extra mesna. Many people go home at the end of this day.

Days 5 to 14

White blood cell booster shots. Blood counts are lowest around days 7 to 14, so infection and bleeding risk are highest.

Days 14 to 21

Counts recover. Blood tests, possibly stem cell collection, then the next cycle or a scan.

Common side effects and what helps

• Very low blood counts. Many people need a blood or platelet transfusion at some point; your team will check counts often.
• Infection risk. Wash hands often and stay away from sick people.
• Nausea and vomiting. Take your anti-nausea medicines on schedule.
• Tiredness, often strongest in the week after treatment. Rest and keep up light activity when you can.
• Hair loss. It grows back after treatment.
• Confusion, sleepiness or strange dreams from ifosfamide. A family member should watch for this during and soon after treatment.
• Kidney strain and low salts in the blood (such as potassium and magnesium). Drink fluids; your team checks blood tests and may give replacements.
• Mouth sores. Use a soft toothbrush and rinse often with a mild salt and baking soda rinse.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Confusion, extreme sleepiness, seeing things that are not there, or a seizure
• Blood in the urine or pain when you urinate
• Bleeding that will not stop, nosebleeds, or many new bruises
• Shortness of breath or chest pain
• Vomiting or diarrhea that will not stop, or you cannot keep fluids down
• Making much less urine than usual

Good to know

• Ifosfamide can affect the brain. Your team checks you for confusion and will stop the infusion if needed.
• Ifosfamide can irritate the bladder. Mesna and lots of fluids help prevent this, and your urine may be tested for blood.
• You will have a hepatitis B blood test before rituximab, because it can wake up an old hepatitis B infection.
• Kidney function and blood salts are checked before each cycle.
• Plans often include a stem cell transplant afterward, so you may meet the transplant team during RICE.

At home

• Drink plenty of fluids (8 to 10 cups a day) unless your team says otherwise, and urinate often.
• Check your temperature twice a day and any time you feel unwell.
• Have someone stay with you for the first days after treatment in case of confusion.
• Give yourself the booster shots on the days your team tells you, or keep your clinic visits for them.
• Avoid crowds and people with colds when your counts are low.

Questions to ask

• Will I get RICE in the hospital or as an outpatient?
• How many cycles will I get before transplant?
• When and how will my stem cells be collected?
• What happens if the lymphoma does not respond?
• Will I likely need blood or platelet transfusions?

Lymphoma

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.