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Treatment Name: HiDAC (High Dose Ara-C)

HiDAC (High Dose Ara-C) is a Chemotherapy Regimen for Acute Myeloid Leukemia (AML)

How does Hidac chemotherapy work?
High Dose Ara-C, also known as "HiDAC," is designed to kill the remaining cancer cells after induction chemotherapy is completed.

Goals of hidac therapy:
HiDAC is commonly given with the goal of cure or to help keep the leukemia in remission until a bone marrow transplant can be performed.


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  • Cytarabine intravenous infusion, usually given over three hours every 12 hours on Days 1, 3, and 5 (six doses total)
  • For patients with advanced age (e.g. > 60 years old) or with a history of multiple medical problems, the dose of cytarabine may be decreased

Estimated total infusion time for HiDAC consolidation treatment:

  • Up to three hours for each dose of cytarabine on Days 1, 3, and 5 (the first two doses of cytarabine are given 12 hours apart, followed by a 24-hour break; this is repeated until all six doses are given)
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and I.V. fluids, such as hydration, may add more time

HiDAC usually requires a 5-day stay in a hospital.

HiDAC is repeated every 28 to 35 days. This is known as one Cycle. Each cycle may be repeated up to 3 to 4 times, depending upon the response to chemotherapy, or if the plan is to proceed with a bone marrow transplant. Duration of therapy may last up to five months, depending upon response, tolerability, and number of cycles prescribed.

Click here for common HiDAC starting doses.

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


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Side Effects

In clinical studies, the most commonly reported side effects with HiDAC are shown here:

  • Increased bleeding risk [Low platelets; thrombocytopenia] (86%)
  • Neutropenic fever (71%)
  • Neurological toxicity (12%)
  • Cytarabine does NOT usually cause hair loss. Hair often begins to grow back during HiDAC chemotherapy

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaNeutropenic FeverNeutropenic FeverBleedingBleeding


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How often monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP).

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue chemotherapy as planned, or delay or switch therapy.


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ChemoExperts Tips

  • Corticosteroid eye drops, such as prednisolone, are often started before the first dose of cytarabine to prevent eye irritation known as conjunctivitis. Eye drops may be continued at home for up to 72 hours after the last dose of cytarabine
  • Short term difficulty with writing, walking, or talking may occur but is rare and usually reversible. To prevent these problems, various neurological exercises are done prior to each dose of cytarabine, to test for early signs of toxicity. Examples of these tests include: follow an object with your eyes, repeat various phrases, sign your name, or walk a straight line
  • If there is no longer evidence of leukemia, a white blood cell stimulating shot known as filgrastim or pegfilgrastim (Neulasta®) is sometimes given to increase the number of good white blood cells to help avoid infection
  • Antibiotics, antifungal agents, and antiviral medications are commonly used to prevent 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 to search for other centers offering study medications

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 HiDAC (High Dose Ara-C), 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 HiDAC (High Dose Ara-C). Depending upon your income, they may be able to help cover the cost of:

  • Cytarabine

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 HiDAC (High Dose Ara-C) 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 HiDAC (High Dose Ara-C)

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.

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1. Mayer RJ, Davis RB, Schiffer CA, et al. Intensive Postremission Chemotherapy in Adults with Acute Myeloid Leukemia. N Engl J Med. 1994;331:896-903.

2. Löwenberg B. Sense and nonsense of high-dose cytarabine for acute myeloid leukemia. Blood. 2013;121:26-28.

Created: August 5, 2015 Updated: June 25, 2017

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.

Common Starting Doses

  • Cytarabine 3000 mg/m2 intravenous infusion over 3 hours every 12 hours on Days 1, 3, and 5 (six doses total)
  • For patients with advanced age (e.g. > 60 years old) or with a history of multiple medical problems, the dose of cytarabine may be decreased to 1000-2000 mg/m2 per dose

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

14) Serum calcium