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Treatment Name: 7 + 3 (Cytarabine + Idarubicin)

7 + 3 (Cytarabine + Idarubicin) is a Chemotherapy Regimen for Acute Myeloid Leukemia (AML)

How does 7+3 chemo therapy work?
Each of the medications in 7 + 3 is designed to rapidly kill cancer cells in the blood stream and bone marrow.
“7” – refers to Cytarabine given daily for 7 days
“3” – refers to Idarubicin given daily for 3 days

Goals of therapy:
7 + 3 chemotherapy is given to eliminate leukemia cells from the body and to decrease symptoms from AML, such as bleeding, bruising, and recurrent infections. 7 + 3 induction is commonly given with the goal of cure.

Note: 7+3 may be given using daunorubicin, instead of idarubicin

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Schedule

  • Idarubicin is an intravenous infusion given over 10 to 15 minutes once daily on Days 1, 2, and 3
  • Cytarabine is given as a 24-hour continuous intravenous infusion on Days 1, 2, 3, 4, 5, 6, and 7

Typically, idarubicin and cytarabine are both started on the same day. Idarubicin ends when the third dose is given on Day 3. Cytarabine is infused continuously for 168 hours (Days 1 – 7)

Estimated total infusion time for this treatment:

  • 168 hours (Days 1 – 7)
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

Hospital stay required
"7 + 3" requires a 19- to 28-day stay in a hospital (or sometimes longer), depending upon how well the side effects are tolerated and whether remission is achieved. A bone marrow biopsy is usually performed around Day 14 to check to see if the leukemia is gone. If no leukemia is detected, patients usually go home once their white blood cell count returns to the normal range. Again, this may take 3, 4, or even 5 weeks.

Click here for common 7+3 chemotherapy starting doses

7 + 3 is known as induction chemotherapy. Once complete, patients go on to get consolidation chemotherapy with HiDAC (High-Dose Ara-C) or IDAC (Intermediate-Dose Ara-C). If the bone marrow biopsy on Day 14 shows leukemia, another induction cycle of chemotherapy is usually recommended. This is then referred to as re-induction. Re-induction chemotherapy may be different than 7+3 induction therapy and have different side effects.

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Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with 7 + 3 are shown here. Side effects sometimes have percentage ranges [example: 8 – 29%, neutropenic fever] because they differed between the clinical studies:

Side effect videos Side Effect Videos
Hair LossHair LossNeutropenic FeverNeutropenic FeverNausea and VomitingNausea and VomitingBleedingBleedingAnemiaAnemiaFatigue Fatigue

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Monitoring

How often monitoring needed?
Labs (blood tests) may be checked before treatment, then daily or every other day for the first few weeks while in the hospital. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), lactate dehydrogenase (LDH), calcium, magnesium, phosphorous, and uric acid, plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment, or during the first month if there is concern for an infection or blood clot. Imaging may include: chest x-ray, or a CT (computed tomography) scan.

How might blood test results/imaging affect treatment?
Depending upon the bone marrow biopsy results from Day 14 (after induction chemotherapy has been given), your doctor may advise to proceed onto consolidation chemotherapy once your normal blood cells recover. If remission has not been achieved with the first induction cycle (this happens in about 35% of patients), another cycle of chemotherapy is usually recommended before you leave the hospital.  This is known as “re-induction chemotherapy.”

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ChemoExperts Tips

  • 7 + 3 induction chemotherapy requires a long stay in the hospital. Try to be as active as possible by taking walks in the hallway, or using an exercise bicycle in the room, if available. This will hopefully speed time to recovery
  • An average of 9 platelet transfusions were required by each patient to prevent bleeding. Be careful not to fall while in the hospital as this is especially dangerous when the platelet count is low
  • Antibiotics, antifungal agents, and antiviral medications are commonly used to prevent infection. Be sure to tell your doctor if you experience discomfort anywhere as this may be a clue to an infection
  • An anti-fungal medication, such as posaconazole, may be prescribed to prevent a life-threatening invasive fungal infection
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for AML. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
  • If you are looking for patient assistance co-pay coverage for medications in the 7 + 3 (Cytarabine + Idarubicin) regimen, we have provided links that may help

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for 7 + 3 (Cytarabine + Idarubicin), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for 7 + 3 (Cytarabine + Idarubicin). Depending upon your income, they may be able to help cover the cost of:

  • Cytarabine
  • Idarubicin

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as 7 + 3 (Cytarabine + Idarubicin) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with 7 + 3 (Cytarabine + Idarubicin)

Individual Drug Label Information

Cytarabine (Ara-C)

  • Cytarabine is most commonly given as an intravenous infusion but may be given subcutaneously
  • FDA Black-Box Warnings for low white blood cells, low platelets, low red blood cells, nausea, vomiting, diarrhea, mouth sores, liver damage, and abdominal pain
  • Dosage adjustments may be required renal or liver function
  • May cause a series of symptoms known as Cytarabine (Ara-C) Syndrome within 6 to 12 hours after administration. Symptoms may include fever, rash, chest pain, muscle aches, bone pain, tiredness, and inflammation and redness of the eye
General Cytarabine (Ara-C) Side Effects
  • Low red blood cells, white blood cells, or platelets
  • Nausea or vomiting
  • Liver dysfunction
  • Click on the cytarabine (Ara-C) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue BleedingBleedingPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Idarubicin (Idamycin®)

  • Idarubicin is administered as an intravenous infusion and is red in color
  • Is commonly infused over 10 – 15 minutes
  • Can affect heart function. A heart study (echocardiogram) may be required before receiving the first dose
  • Dosage may be reduced in patients with poor liver function
  • Has been linked to the development of other cancers in a small number of people (1.5% chance at 10 years)
General Idarubicin (Idamycin) Side Effects
  • Increases your risk of bleeding.  It is normal to receive red blood cell & platelet transfusions if receiving idarubicin
  • May cause nausea, vomiting, diarrhea, and mouth sores (stomatitis)
  • Leakage into skin or surrounding muscle may cause severe irritation (extravasation)
  • May temporarily turn urine orange
  • Causes hair loss, This is usually temporary and reversible
  • May increase the risk of infection due to decrease white blood cell count (neutropenia). It is normal to receive I.V. antibiotics after idarubicin is infused
  • Click on the idarubicin (Idamycin) package insert below for reported side effects and potential drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingHair LossHair LossFatigue Fatigue BleedingBleedingAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1. Ohtake S, Miyawaki S, Fujita H, et al. Randomized study of induction therapy comparing standard-dose idarubicin with high-dose daunorubicin in adult patients with previously untreated acute myeloid leukemia: the JALSG AML201 study. 2011;117:2358-2365.

2. Pautas C, Merabet F, Thomas X, et al. Randomized study of intensified anthracycline doses for induction and recombinant interleukin-2 for maintenance in patients with acute myeloid leukemia age 50 to 70 years: results of the ALFA-9801 study. J Clin Oncol. 2010;28:808-814.

3. Teuffel O, Leibundgut K, Lehrnbecher T, et al. Anthracyclines during induction therapy in acute myeloid leukaemia: a systematic review and meta-analysis. Br J Haematol. 2013;161:192-203.

Created: August 9, 2015 Updated: September 5, 2018

What is Acute Myeloid Leukemia (AML)?

A disease of the myeloid cells found in the bone marrow. Myeloid cells are responsible for developing into mature white blood cells, red blood cells, and platelets. In AML, immature myeloid cells know as “blasts” replicate at a very fast rate. Sometimes blasts crowd out the normal cells in the bone marrow so that red blood cells or platelets are unable to develop. Common symptoms of this include fatigue, difficulty exercising, or easy bruising or bleeding.

Most cases of AML are considered “de novo” meaning that the cause is unknown. However, there are a few known risk factors for AML, such as exposure to radiation, various environmental toxins, and certain chemotherapy agents. There is no staging system for AML. Chromosomes (strands of DNA) are often analyzed to determine which mutations in the chromosomes exist. The effectiveness of the treatment may depend upon the specific chromosome mutations that are present.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1. Ohtake S, Miyawaki S, Fujita H, et al. Randomized study of induction therapy comparing standard-dose idarubicin with high-dose daunorubicin in adult patients with previously untreated acute myeloid leukemia: the JALSG AML201 study. 2011;117:2358-2365.

2. Pautas C, Merabet F, Thomas X, et al. Randomized study of intensified anthracycline doses for induction and recombinant interleukin-2 for maintenance in patients with acute myeloid leukemia age 50 to 70 years: results of the ALFA-9801 study. J Clin Oncol. 2010;28:808-814.

3. Teuffel O, Leibundgut K, Lehrnbecher T, et al. Anthracyclines during induction therapy in acute myeloid leukaemia: a systematic review and meta-analysis. Br J Haematol. 2013;161:192-203.

What is Induction Chemotherapy?

an intensive cycle of chemotherapy that requires hospitalization. Induction chemotherapy often requires intense monitoring by hospital staff to ensure that infections are treated and blood or platelet transfusions are given when needed. The goal of induction chemotherapy is to achieve a complete remission, meaning no leukemia cells are detectable.

What if a bicycle is not available?

Some hospitals allow family members to purchase a new bicycle and bring it in fully assembled. Ask your nurse if this may be an option!

Common Starting Doses

  • Idarubicin 12 mg/m2 intravenous infusion over 10 to 15 minutes once daily on Days 1, 2, and 3
  • Cytarabine 100 mg/m2 (or 200 mg/m2) per day by 24-hour continuous intravenous on Days 1, 2, 3, 4, 5, 6, and 7

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

Posaconazole

Posaconazole is an anti-fungal medication that has been shown in a large, randomized clinical trial to prevent life-threatening fungal infections in patients with AML receiving induction chemotherapy

Patient assistance & co-payment coverage for 7 + 3 (Cytarabine + Idarubicin)

If you are underinsured and need help with paying for 7 + 3 (Cytarabine + Idarubicin), click the links on our Friends page to see if funding is available. Depending upon your income, they may be able to help cover the cost of:

  • Idarubicin
  • Cytarabine

Note: Funding is not always available at the time you check, but may become available in the future. If funding is currently closed for the medications you are looking for, please check back another time. Proof of income may be required.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.