ICE, DHAP and ESHAP: — Second-Line Regimens for Lymphoma

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.

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.

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.

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.

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.

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.