Induction therapy in acute myeloid leukemia: Is it time to put aside standard 3 + 7?

For more than 30 years after its introduction, the combination of an anthracycline, usually daunorubicin, given for 3 days with continuous infusion of cytarabine for 7 days (3 + 7) has been the standard induction regimen for patients with acute myeloid leukemia (AML). In the last decade, there has been a progressive understanding of the molecular pathogenesis of the disease, which has led to discovery of potential therapeutic targets, resulting in selective treatment approaches aimed at rational and personalized treatment strategies. In the last 2 years, different new agents for AML have become widely available for newly diagnosed or relapsing/refractory patients, and others are object of clinical investigation. For most treatment-naïve patients, it is now evident that standard 3 + 7 represents undertreatment in that the addition of new compounds results in better quality of response and improved survival. Hopefully, within few years, no patients with AML will be given standard 3 + 7 in the daily practice and a personalized approach targeting driving mutations will be widely applied.