HiDAC

Say it: HIGH-dack

High dose cytarabine, with or without midostaurin

HiDAC means high doses of the chemotherapy cytarabine, given to people with acute myeloid leukemia (AML) after the first treatment has put the leukemia into remission.

Also called: High dose cytarabine, HDAC, High dose Ara-C, HiDAC consolidation, HiDAC with midostaurin, Intermediate dose cytarabine (IDAC)

What it is

After the first treatment (often 7+3) clears the leukemia from the blood and bone marrow, a few hidden leukemia cells usually remain. HiDAC is given in several rounds to wipe out these remaining cells. The goal is cure, or to keep the leukemia away long enough to move to a stem cell transplant if one is planned.

Often used for

• Acute myeloid leukemia (AML) after remission, to keep it from coming back (called consolidation)
• AML with a FLT3 gene change, together with midostaurin
• Sometimes AML that came back or did not respond

HiDAC alone

Used after remission for many people with AML, especially those with favorable gene changes (such as core binding factor AML).

HiDAC with midostaurin

For AML with a FLT3 gene change. Midostaurin capsules are taken after the cytarabine part of each cycle to target the FLT3 signal that helps the leukemia grow.

The medicines in this plan

Cytarabine (Ara-C)

Chemotherapy that stops leukemia cells from copying their DNA. Given through a vein over about 3 hours, often every 12 hours on days 1, 3 and 5.

Midostaurin

Only for AML with a FLT3 gene change. A capsule taken by mouth twice a day with food, usually on days 8 to 21 of each cycle.

How you get it

HiDAC may be given in the hospital or, at some centers, in an outpatient clinic with very close follow up. Each round of cytarabine takes about 5 days, and then you recover while blood counts drop and come back up. Rounds are usually given about every 4 to 5 weeks, for 3 to 4 rounds in total. Your schedule may be different.

A typical cycle

Days 1 to 5

Cytarabine through a vein, often every 12 hours on days 1, 3 and 5. Steroid eye drops are started to protect your eyes. Your nurse checks your balance, speech and handwriting before each dose.

Days 8 to 21

Midostaurin capsules twice a day, if your AML has a FLT3 change.

Days 7 to 25

Blood counts are low. You may need blood or platelet transfusions and infection prevention medicines. Many people come to the clinic 2 to 3 times a week for blood tests.

Days 25 to 35

Counts recover, and the next round starts once they are high enough.

Common side effects and what helps

• Very low blood counts for 1 to 3 weeks, with high infection risk. Wash hands often, avoid crowds and sick people, and follow food safety rules.
• Red, gritty or sore eyes. Use the steroid eye drops exactly as prescribed, until a few days after the last dose.
• Nausea and vomiting. Take your anti-nausea medicines on schedule.
• Tiredness. Rest often; energy improves as counts come back.
• Fever or rash during the days cytarabine is given. Tell your nurse; it is often treatable.
• Mouth sores. Rinse often with a mild salt and baking soda rinse and use a soft toothbrush.
• Easy bruising or bleeding from low platelets. Use an electric razor and a soft toothbrush.
• With midostaurin: nausea, vomiting and headache. Take it with food.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• New trouble walking, poor balance, slurred speech, shaky hands or messy handwriting
• Bleeding that will not stop, blood in urine or stool, or many new bruises
• Trouble breathing or chest pain
• Eye pain or a change in vision
• Vomiting so much you cannot keep fluids or medicines down
• Feeling very weak, dizzy or confused

Good to know

• High dose cytarabine can affect the part of the brain that controls balance and coordination (the cerebellum), especially in older adults or people with kidney problems. Your team checks for this before every dose.
• Steroid eye drops are used to prevent painful eye irritation.
• Frequent blood tests and transfusions are a normal part of this treatment.
• You may take medicines to prevent bacterial, fungal and viral infections while counts are low.
• A bone marrow test may be repeated to check that the leukemia is still in remission.
• Midostaurin can interact with many other medicines. Tell your team about every medicine and supplement you take.

At home

• Check your temperature twice a day and any time you feel unwell, and keep the after hours phone number handy.
• Use your eye drops on schedule, even if your eyes feel fine.
• Avoid raw or undercooked meat, eggs and fish, and wash fruits and vegetables well.
• Drink plenty of fluids and eat small meals when nausea is a problem.
• Take midostaurin twice a day with food, about 12 hours apart.

Questions to ask

• How many rounds of HiDAC will I get?
• Will I stay in the hospital or come to the clinic?
• Does my AML have a FLT3 change, and will I take midostaurin?
• Am I a candidate for a stem cell transplant?
• Which infection prevention medicines will I take?

Leukemia

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.