RICE is the name of a combination of cancer drugs that includes:
It is a treatment for non-Hodgkin lymphoma or Hodgkin lymphoma that has come back after treatment. Most people who have this type of treatment also have a stem cell transplant. Your doctor or nurse will explain this treatment to you in detail.
How RICE works
Ifosfamide, carboplatin and etoposide are chemotherapy drugs. They destroy quickly dividing cells, such as cancer cells.
Rituximab is a type of targeted drug called a monoclonal antibody. Monoclonal antibodies target proteins on the surface of cells. Rituximab targets a protein known as CD20. CD20 is found on white blood cells called B cells. It is the B cells that are cancerous in the most common types of lymphoma.
Rituximab attaches itself to the B cells and marks them. The cells of immune system then recognise the marked cells and kill them.
How you have RICE
You have all the drugs as a drip into your bloodstream (intravenously).
Into your bloodstream
You can have the drug through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have it through a long line: a central line, a PICC line or a portacath.
These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.
Mesna and GCSF
You usually have ifosfamide with another drug called mesna. You have mesna either as a drip (infusion) into your bloodstream or as tablets.
Mesna is not a chemotherapy drug. It stops the ifosfamide from irritating your bladder and making the lining bleed.
You usually also have a drug called granulocyte colony stimulating factor (GCSF). This makes your bone marrow produce white blood cells more quickly after the chemotherapy.
When you have RICE
You have RICE as cycles of treatment. Each cycle lasts 3 weeks. You usually have 3 cycles of treatment.
Some people have an allergic reaction to rituximab. This can cause flu like symptoms such as fever and sickness. To prevent an allergic reaction you usually have the first dose of rituximab slowly over a few hours. You may also have paracetamol, steroids and an antihistamine drug before the treatment.
Different hospitals give RICE in different ways. A common way of having RICE is described below.
- You have rituximab as a drip into your bloodstream.
- You have etoposide as a drip into your bloodstream.
- You have etoposide as a drip into your bloodstream.
- You have carboplatin as a drip into your bloodstream.
- You have ifosfamide as a drip into your bloodstream.
- You have etoposide as a drip into your bloodstream.
- You have no treatment.
You then start a new cycle of treatment. You may need to stay in hospital overnight between day 2 and 3 of each cycle.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
Common side effects
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Risk of infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Bruising and bleeding
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
Tiredness and weakness
Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Loss of appetite
You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.
Tummy (abdominal) pain
Tell your treatment team if you have this. They can check the cause and give you medicine to help.
You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.
You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before.
To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.
Irritation of the lining of the bladder
This treatment can irritate your bladder and kidneys. Drink as much water as possible to flush out the drugs. Make sure that you pass urine often, especially before you go to sleep. You might also have a drug called Mesna to protect your bladder and kidneys.
Changes in the levels of minerals in your body
You may have changes in levels of minerals and salts in your blood, including low levels of sodium or high levels of uric acid (causing gout). You have regular blood tests during treatment to check this.
Inflammation around the drip site
Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.
A rash can also be itchy. Tell your doctor or nurse if you have a skin rash. They can prescribe medicine to stop the itching and soothe your skin.
An allergic reaction
A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction.
Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.
High temperature (fever) and chills
You might get a high temperature (fever), weakness and chills. Contact your doctor or nurse if you have this.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
- dizziness and anxiety
- heart problems such as an irregular heartbeat and changes to your blood pressure levels
- loose or watery poo (diarrhoea)
- a sore mouth and taste changes
- numbness or tingling in fingers and toes that can make it difficult to do fiddly things such as doing up buttons
- weight loss
- hearing loss especially with high pitched sounds and ringing in your ears (tinnitus)
- problems with your eyes such as inflammation and increased production of tears
- lung problems that can cause difficulty breathing, cough and chest pain
- a second cancer some years after treatment
- a severe infection called sepsis that can be life threatening
- swelling (oedema) in your face, arms and legs
- pain in different parts of the body such as your muscles, joints, back, neck and the tumour site
Rare side effects
These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:
- fits (seizures)
- a build up of scar tissue in your lungs (fibrosis)
- a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You may also feel feverish and your eyes might be more sensitive to light. This is serious and could be life threatening
- severe heart problems such as angina and a heart attack
- a hole in the bowel, stomach or food pipe
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know
Other medicines, foods and drinks
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Loss of fertility
You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Contraception and pregnancy
This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least a year afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Don’t breastfeed during this treatment and for 12 months afterwards because the drugs may come through in the breast milk.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.