rituximab + cyclophosphamide + doxorubicin + vincristine + prednisone + ifosfamide + carboplatin + etoposide

This response-adapted treatment intensification regimen is designed for patients with aggressive B-cell lymphomas, specifically diffuse large B-cell lymphoma (DLBCL) and mediastinal (thymic) B-cell lymphoma. Developed and evaluated by the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, the protocol utilizes a risk-stratified approach based on early [18F] FDG-PET scanning. Patients initially receive standard R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Those who remain PET-positive after three cycles—indicating a high risk of relapse—are transitioned to an intensification regimen consisting of R-ICE (rituximab, ifosfamide, carboplatin, and etoposide) followed by high-dose cyclophosphamide (HiCy). This multi-agent strategy combines the anti-CD20 immunotherapy of rituximab with a broad spectrum of cytotoxic mechanisms, including DNA alkylation, topoisomerase II inhibition, and microtubule disruption, to overcome chemoresistance and improve remission durability in high-risk populations.

Other names

R-CHOPR-ICEHiCyR-ICE + High-Dose CyclophosphamideR-ICE + HiCy intensification