Systemic Anti-Cancer Therapy Regimen Library
DAUNOrubicin, cytarabine and midostaurin induction [under 60 years] (LEU AML - DAUNOrubicin, cytarabine and midostaurin induction, high dose cytarabine and midostaurin consolidation followed by midostaurin maintenance [FLT3 mutated] [under 60 years])
Treatment Overview
This regimen is usually given once but may be repeated (after 28 days or on count recovery) at the clinicians discretion if remission is not achieved.
Cycles 1 to 2 - 28 days
midostaurin: Cardiovascular risk factor assessment is recommended—consult prescribing information for details.
Cycle details
Cycles 1 to 2 - 28 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| DAUNOrubicin * | 60 mg/m² Once daily | intravenous | 1, 2, 3 | 15 minutes |
| cytarabine | 200 mg/m² Once daily | intravenous | 1 to 7 | 24 hours Min: 24 hours |
| midostaurin | 50 mg Twice daily | oral administration | 8 to 21 |
midostaurin: Cardiovascular risk factor assessment is recommended—consult prescribing information for details.
Full details
Cycles 1 to 2 - 28 days
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| DAUNOrubicin * | 60 mg/m² Once daily | intravenous | 15 minutes |
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. |
| cytarabine | 200 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days). |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| DAUNOrubicin * | 60 mg/m² Once daily | intravenous | 15 minutes |
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. |
| cytarabine | 200 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days). |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| DAUNOrubicin * | 60 mg/m² Once daily | intravenous | 15 minutes |
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. |
| cytarabine | 200 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days). |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| cytarabine | 200 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days). |
Day: 5
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| cytarabine | 200 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days). |
Day: 6
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| cytarabine | 200 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days). |
Day: 7
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| cytarabine | 200 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days). |
Day: 8
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 9
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 10
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 11
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 12
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 13
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 14
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 15
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 16
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 17
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 18
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 19
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 20
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Day: 21
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| midostaurin | 50 mg Twice daily | oral administration |
Instructions:
|
Supportive Care Factors
| Factor | Value |
|---|---|
| Antifungal prophylaxis: | Routine antifungal prophylaxis recommended |
| Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis recommended |
| Emetogenicity: | Variable |
| Tumour lysis syndrome prophylaxis: | Tumour lysis syndrome prophylaxis is recommended |
Antifungal prophylaxis: Azole antifungals may reduce the clearance of midostaurin and increase its toxicity. Avoid combination or monitor for midostaurin toxicity.
Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.
Emetogenicity:
- MEDIUM days 1 to 3
- LOW days 4 to 7
- MEDIUM to HIGH (oral) days 8 to 21.
Tumour lysis syndrome prophylaxis: Recommended for first cycle of treatment and only for further cycles if not in complete remission.
References
Novartis New Zealand Limited Rydapt Data sheet 14 May 2021 https://www.medsafe.govt.nz/profs/Datasheet/r/rydaptcap.pdf (accessed 14 July 2022).
* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.
s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.