What Is the 3+7 Protocol?

Definition, Medications, What to Expect and Side Effects of the 7 + 3 Regimen

What is the 3 + 7 protocol and what should I know before receiving it?. Istockphoto.com/Stock Photo©sframephoto

If you've been told that your doctor recommends the 3 + 7 protocol for leukemia, you probably have many questions.  Let's take a look at what this means.

What is the 3 + 7 Protocol?

The 3+7 protocol (also called the 7+3 regimen) is a combination drug protocol used as induction chemotherapy for most types of acute myelogenous leukemia (AML).

What is Induction Therapy?

Induction therapy is usually the initial therapy you are given after a diagnosis of leukemia.

  The goal of this treatment is to lower the leukemia cells in your blood to undetectable levels - in other words, to levels where a slide of your blood would not show any cancer cells at all.  The other main goal of induction therapy is to clear your bone marrow of enough cancer cells so that the normal production of blood cells by your bone marrow returns.  Unfortunately, cancer often recurs after a remission with this induction therapy, and further treatments are usually needed.

Medications in the 3 + 7 Protocol

This protocol is called 3 + 7 because it consists of:

  • 3 days of an anthracycline, usually either Idamycin (idarubicin) or Cerubidine (daunorubicin)
  • 7 days of Cytosar U or Depocyt (cytarabine)

How is it Given?  Will I Be in the Hospital?

Since the cytarabine therapy will be given around the clock for 7 days straight, you will usually be an inpatient at the hospital.  This chemotherapy is administered (given) through either an intravenous (IV) or central venous catheter.

The antracycline component will be given daily as an intravenous injection, over about 10 to 15 minutes per dose.

What to Expect - Common Side Effects

Since chemotherapy kills rapidly dividing cells such as cancer cells, it also impacts cells that normally divide rapidly such as those in your bone marrow, on your scalp, and in your digestive tract.

  Some of the side effects you may experience include:

  • Bone marrow suppression - Suppression of dividing cells in your bone marrow (bone marrow suppression) can result in a low red blood cell count (anemia) a low neutrophil (a type of white blood cell) count (neutropenia) and a low platelet count (thrombocytopenia.)  It will be very important for you to avoid infections if at all possible, and it's recommended that any loved ones refrain from visiting if they are ill.
  • Nausea and vomiting - The prevention and treatment of chemotherapy-induced nausea and vomiting has come very far in recent years, and some people have only minimal symptoms.  You will be given medications to help prevent nausea, and may also be given additional medications if needed to control your symptoms.
  • Hair loss - You will likely lose your hair during this regimen.  Some people are surprised to learn that you will also lose your eyebrows, eyelashes, and body hair.
  • Mouth sores - Mouth sores can be irritating, and it's helpful to know what foods can make them more painful, and what foods are most comfortable to eat.  Your doctor may have you suck on a popsicle or ice chips while receiving the anthracycline therapy to help minimize this symptom.
  • Red/orange colored urine - The anthracycine medication - nicknamed the "red devil" by some cancer patients, results in passing red urine for a day or so after each dose.  Don't be alarmed by this symptom as it is not dangerous and does not mean there is any problem with your kidneys or bladder.
  • Diarrhea - Your doctor will monitor you closely for diarrhea.  If you do develop diarrhea you will be watched very closely to make sure you do not become dehydrated.

As with any type of medication, each person will react to the 3+7 protocol differently and may experience all or none of these side effects.

What to Watch For

Anthracycline medications are vesicants, which means they can cause damage to your tissues if they are accidentally infused into the skin instead of into your vein. While it is very unusual for this to happen, it is important that you tell your healthcare provider if your vein feels painful or tingly while you are receiving this medication.


The 3 + 7 protocol is usually given 14 days apart and may be given, on average, once or twice until you have no detectable cancer cells.  This protocol very often results in complete remission, but the cancer can come back so further treatments are then needed.

Support and Coping

Cancer is difficult enough to deal with even if you don't have to spend extended periods of time in the hospital.  Reach out to family and friends.  If it's your loved one receiving this protocol, check out these tips for visiting someone in the hospital, and what to bring/pack for chemotherapy.  Emotions can be a roller coaster, sometimes even in the same hour of the day.  Don't try to be a hero and let people help you.  A comment we so often hear is that loved ones feel helpless.  Think of some way in which they can help you as a gift to both yourself and to them.  And check out these tips on coping with a diagnosis of leukemia.


Larson, R. Patient information: Acute myeloid leukemia (AML) treatment in adults (Beyond the Basics). UpToDate. Updated 11/18/15. http://www.uptodate.com/contents/acute-myeloid-leukemia-aml-treatment-in-adults-beyond-the-basics

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