Reduced burden of infection with consecutive day dosing of high dose cytarabine consolidation versus conventional dosing for acute myeloid leukemia

High-dose cytarabine given on days 1, 3, and 5 (HDAC-135) is a mainstay of consolidation treatment for acute myeloid leukemia (AML). Recent evidence indicates that consecutive daily dosing (HDAC-123) accelerates hematologic recovery and reduces hospitalization duration without compromising survival. However, the impact of HDAC-123 on infection outcomes is unclear. We performed a retrospective analysis of 73 AML patients undergoing HDAC consolidation, including 24 (33%) patients aged ≥60 years. Thirty-six patients received HDAC-135, and 37 received HDAC-123. HDAC-123 was associated with a shorter duration of neutropenia (8 versus 10 days, <i>p</i> < .001), fewer neutropenic infections (58% versus 79%, <i>p</i> = .02), and a reduced cumulative number of bacteremia episodes per patient (1.54 versus 3.30, <i>p</i> = .03), particularly from Gram-negative pathogens (1.22 versus 3.15, <i>p</i> = .003) compared to HDAC-135. HDAC-123 was well tolerated across all ages and demonstrated improvements in infection-related complications, supporting its use as a safe and effective consolidation strategy in AML.