Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

7+3 regimen (AML induction) and high-dose cytarabine

Cytarabine for 7 days and daunorubicin for 3 days; midostaurin if FLT3-positive; HiDAC consolidation

Updated: 28 October 20261 min read4 references

Summary for doctors

  • AML in patients fit for intensive treatment [1].
  • Daunorubicin 90 vs 45: higher response and longer survival [1].
  • FLT3-positive: midostaurin on days 8 to 21 [2].
  • Have the genetic test results (especially FLT3 and NPM1) by day 5 to 7.

Dose and schedule

7+3

AML, first induction

AML, first induction

DrugDoseRouteSchedule
Cytarabine100 mg/m² a dayContinuous infusionDays 1 to 7
Daunorubicin (or idarubicin 12 mg/m²)60 to 90 mg/m²IVDays 1 to 3
Midostaurin (FLT3-positive only)50 mg twice a dayOral, with foodDays 8 to 21
Cycle length
One cycle; bone marrow assessment around day 14 and after count recovery
Duration
One to two induction cycles

Daunorubicin 90 as in E1900 [1]; midostaurin as in RATIFY [2].

Dose source: [4].

Evidence: RATIFY (CALGB 10603) (2017)

High-dose cytarabine (HiDAC)

Consolidation in favourable- or intermediate-risk AML, under 60 years

Consolidation in favourable-‎ or intermediate-risk AML, under 60 years

DrugDoseRouteSchedule
Cytarabine3 g/m² every 12 hours (under 60 years)IV over 3 hoursDays 1, 3 and 5
Midostaurin (FLT3-positive)50 mg twice a dayOralDays 8 to 21
Cycle length
Every 28 to 35 days after count recovery
Duration
3 to 4 cycles (or allogeneic transplant in the high-risk group)

As in CALGB 8525 [3].

Dose source: [4].

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • Tumour lysis prevention (hydration, allopurinol; rasburicase at high risk) (TLS tool).
  • Antifungal prophylaxis (posaconazole) during induction; a fluoroquinolone and antiviral per protocol.
  • HiDAC: steroid eye drops to prevent conjunctivitis.
  • Echocardiogram before the anthracycline.

Monitoring and dose adjustment

  • HiDAC: cerebellar examination before each dose (handwriting, gait, nystagmus); stop with cerebellar signs or a raised creatinine.
  • Midostaurin levels are higher with strong CYP3A4 inhibitors (posaconazole); monitor for toxicity.
  • MRD after induction and consolidation (especially NPM1).

Main evidence

Show detailsHide

E1900: daunorubicin 90 vs 45 increased complete remission from 57.3% to 70.6% and median survival from 15.7 to 23.7 months [1]. RATIFY: midostaurin improved overall survival in FLT3-positive disease [2]. CALGB 8525: cytarabine 3 g/m² improved disease-free survival under 60 years but gave no benefit over 60 years and caused more neurotoxicity [3].

Related cancer types

Leukaemia

Treatment regimens (physicians)

BR regimen (bendamustine and rituximab)Azacitidine with venetoclax in AMLTretinoin (ATRA) and arsenic trioxide in APLVenetoclax and obinutuzumab in CLL (the 12-month CLL14 regimen)

Physician tools and lessons

Cumulative Anthracycline Dose and Doxorubicin EquivalentsTumour Lysis Syndrome: Cairo-Bishop Criteria and PreventionHCT-CI Comorbidity Index Before Stem Cell TransplantationCLL-IPI Calculator (Chronic Lymphocytic Leukaemia Prognostic Index)ELTS and Sokal Score Calculator in Chronic Myeloid Leukaemia (CML)IPSS-R Calculator for Myelodysplastic Syndromes (MDS)ELN 2022 Genetic Risk Classification of AMLIndications for haematopoietic stem cell transplantation, donor selection and conditioningGraft-versus-host disease (GVHD): prophylaxis, grading and treatment10 cheap steps that save patients' lives

References

4 references
Show all references, 1 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    Anthracycline dose intensification in acute myeloid leukemiaFernandez HF, Sun Z, Yao X, et al · N Engl J Med · 2009;361:1249-59
    DOIPubMed Back to text: 1 2 3 4
  2. 2
    Midostaurin plus Chemotherapy for Acute Myeloid Leukemia with a FLT3 MutationStone RM, Mandrekar SJ, Sanford BL, et al · N Engl J Med · 2017;377:454-464
    Study cardDOIPubMed Back to text: 1 2 3
  3. 3
    Intensive postremission chemotherapy in adults with acute myeloid leukemia. Cancer and Leukemia Group BMayer RJ, Davis RB, Schiffer CA, et al · N Engl J Med · 1994;331:896-903
    DOIPubMed Back to text: 1 2
  4. 4
    RYDAPT — Prescribing InformationNovartis Pharmaceuticals Corporation · FDA label · 2026
    Source Back to text: 1 2

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/7-plus-3-aml-induction/

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