ICE, DHAP and ESHAP: — Second-Line Regimens for Lymphoma
If your lymphoma has returned after treatment, or did not respond to initial chemotherapy, your oncologist may discuss one of three salvage regimens: ICE, DHAP or ESHAP. Here is what each acronym means, what to expect during treatment, and why hospital admission is usually needed.
- Second-line setting — These regimens are used after first-line chemotherapy has failed — not as the first treatment given.
- Each acronym names its drugs — ICE, DHAP and ESHAP are acronyms — each letter stands for a drug in the combination.
- Hospital admission is typical — Most cycles of DHAP and ESHAP require inpatient admission; ICE is also commonly given in hospital.
- Often a step toward transplant — Salvage chemotherapy is frequently used to prepare for an autologous stem cell transplant.
Medically reviewed by Dr. Owais Mohammed, Medical Oncologist · Last reviewed September 2026
ICE, DHAP and ESHAP are second-line chemotherapy regimens used when lymphoma returns after first-line treatment, or does not respond to it. Each brings together multiple drugs to bring the disease under control again. They are usually given in hospital over several days and are often used as a step toward a stem cell transplant.
What drugs are in ICE, DHAP and ESHAP?
- ICE
- Ifosfamide, carboplatin and etoposide. The name is formed from the first letters of each drug. ICE is used for relapsed or refractory aggressive lymphomas, including diffuse large B-cell lymphoma and Hodgkin lymphoma.
- DHAP
- Dexamethasone, high-dose cytarabine (also called Ara-C) and cisplatin. DHAP is used in much the same setting as ICE — when lymphoma has returned or not responded — and is also commonly chosen when treatment is being planned toward a stem cell transplant.
- ESHAP
- Etoposide, methylprednisolone, high-dose cytarabine (Ara-C) and cisplatin. ESHAP shares three of its four drugs with DHAP but adds etoposide. It is used in the same second-line settings and carries a similar side-effect profile to DHAP.
What happens during a treatment admission?
- Blood tests are done before each cycle to check your kidney function, blood counts and liver.
- A drip line is placed — sometimes a central line or PICC line is inserted for the duration of treatment.
- Fluids are run alongside the drugs to protect the kidneys, particularly when cisplatin is part of the regimen.
- Anti-nausea medicines are given routinely from the start — nausea is anticipated and managed, not left to develop.
- Temperature is monitored throughout. Tell a nurse at once if you feel feverish or suddenly unwell.
- Blood counts are checked regularly after each cycle, as they will fall in the week or two that follows.
Who should not receive ICE, DHAP or ESHAP?
ICE, DHAP and ESHAP are intensive second-line regimens. They are not used for patients who have not previously received lymphoma treatment — these are designed specifically for relapsed or refractory disease.
They are generally not used in:
- Patients with significantly impaired kidney function, particularly for DHAP and ESHAP, which contain cisplatin — a drug processed by the kidneys
- Patients with severely reduced heart function
- Patients with very poor general fitness or performance status, where the intensity of treatment would be unlikely to be tolerated
- Patients with active, uncontrolled serious infection
- Patients with severely compromised bone marrow reserve
Eligibility is always decided by an oncologist on the individual case, taking into account the specific regimen, the lymphoma's behaviour, prior treatment received, and the patient's overall health.
Is hospital admission always needed for these regimens?
DHAP and ESHAP are almost always given as inpatient treatment. The high-dose cytarabine and cisplatin they contain require continuous hydration and close monitoring over multiple days.
ICE is also commonly given in hospital, though some specialist centres may offer modified approaches for selected patients that allow partial outpatient care. Your oncologist will tell you what applies in your case.
Expect a stay of several days for each cycle. The exact length depends on the specific regimen, how your body tolerates treatment, and when your team is satisfied that you are safe to go home.
Why are salvage regimens used before a stem cell transplant?
When a stem cell transplant is being planned, salvage chemotherapy serves two purposes. The first is to bring the lymphoma back under control. The second is to move enough stem cells from the bone marrow into the bloodstream so they can be collected.
This collection — called stem cell mobilisation — happens after chemotherapy, as white blood cell counts recover. The stem cells gathered from your blood are stored, then returned to you after the high-dose treatment that precedes transplant.
Not every patient who receives ICE, DHAP or ESHAP goes on to transplant. Whether that step follows depends on how the disease responds to salvage treatment and on your overall fitness. Your oncologist will reassess after each cycle.
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- Stopping Early: What Happens If You Do Not Complete the Course?
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HUB — Chemotherapy Regimens
HUB — Cycles, Schedules and What Happens on Infusion Day
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- Oral Chemotherapy: Tablets Instead of a Drip
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- Topical Chemotherapy Creams
- What Safety Checks Happen Before Each Dose?
- Who Actually Gives Your Chemotherapy?
- Why Does the Route Sometimes Change During Treatment?
Regimens, Cycles & Schedules
- A Printable Chemotherapy Cycle Calendar
- Adding or Removing Cycles Mid-Course
- Blood Tests Before Every Cycle: What They Check
- Day 1, Day 8, Day 15: What the Day Numbers Mean
- Does Delaying a Cycle Reduce the Benefit?
- How Many Cycles Before the First Assessment?
- How the Dose Is Calculated for You
- Keeping a Chemotherapy Symptom Diary
- Planning Your Life Around Chemotherapy Cycles
- Rescheduling or Missing a Chemotherapy Appointment
- Weekly, Two-Weekly and Three-Weekly Schedules
- What Happens Between Cycles?
- What Happens at the Last Cycle?
- What Is Dose Intensity?
- What Is a Chemotherapy Cycle?
- What Is the Nadir and Why Does It Matter?
- Which Days of the Cycle Will I Feel Worst?
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The Infusion Day
Your First Cycle
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Frequently asked questions
How many cycles of ICE, DHAP or ESHAP are usually given?
Typically two to three cycles are given before response is assessed, though the exact number is not fixed at the start. Some patients proceed after two cycles if the disease is responding and enough stem cells have been collected. Others may need an additional cycle. Your oncologist will reassess after each cycle rather than committing to a set number in advance, because the decision depends on how your lymphoma is behaving and what the next planned step is.
What side effects should I call my team about straight away?
Call the same day if you develop a fever, feel suddenly unwell, or notice signs of infection — blood counts fall significantly after each cycle, and infection during this period can be serious. Also report blood in your urine, a marked drop in how much you are passing, chest pain, or difficulty breathing. These regimens affect the kidneys, bone marrow and, in some cases, the heart. Your team needs to know about any of these promptly rather than at your next scheduled visit.
Can ICE, DHAP or ESHAP be given without planning a transplant?
Yes. Although these regimens are often used as a bridge to stem cell transplant, they are also given in some situations where transplant is not the goal — for example, in patients who are not fit enough for transplant, or where disease control is the primary aim. The decision about whether transplant is being planned is separate from the decision to start salvage chemotherapy, and your oncologist will explain which situation applies to you.
Are ICE, DHAP and ESHAP the same, or is one better than the others?
They are not the same — each uses a different drug combination. DHAP and ESHAP overlap more closely with each other than either does with ICE. NCCN and ESMO guidance recognises all three as accepted second-line options for eligible patients with relapsed or refractory aggressive lymphoma. The choice between them depends on factors including prior treatment received, kidney and heart function, and centre experience. Your oncologist will explain the reasoning behind the regimen chosen for you.
Are these regimens used for all types of lymphoma?
No. ICE, DHAP and ESHAP are used most commonly for aggressive B-cell lymphomas — particularly diffuse large B-cell lymphoma — and for relapsed or refractory Hodgkin lymphoma. They are not standard for every lymphoma subtype. Indolent lymphomas, T-cell lymphomas and other subtypes are often treated with different approaches. Your oncologist will tell you whether the regimen being discussed is appropriate for the specific type and stage of lymphoma you have.
What if the disease does not respond to salvage treatment?
If lymphoma does not respond to one salvage regimen, a different regimen may be tried. There is no single universal option for second-salvage treatment, and what is available depends on what you have already received and the biology of your disease. Your oncologist will discuss realistic options if the first regimen does not achieve adequate disease control. We do not yet have a treatment that is reliable in all refractory lymphomas, and your team will be honest with you about what the evidence supports for your situation.
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