idarubicin + dexamethasone + cytarabine + thioguanine + etoposide

IDA-DCTER is an intensive multi-agent chemotherapy induction regimen used in the treatment of pediatric acute myeloid leukemia (AML), notably evaluated in the Children's Cancer Group (CCG) trial CCG-2961. The regimen is a modification of the DCTER protocol, which consists of dexamethasone, cytarabine, 6-thioguanine, etoposide, and daunorubicin. In the IDA-DCTER variant, idarubicin (an anthracycline) replaces daunorubicin in the first induction cycle. The combination leverages multiple mechanisms of action to combat leukemic blasts: idarubicin and etoposide inhibit topoisomerase II and intercalate DNA; cytarabine and 6-thioguanine act as antimetabolites to inhibit DNA synthesis; and dexamethasone is a glucocorticoid that induces apoptosis. This regimen was designed to improve remission rates and event-free survival in high-risk pediatric AML populations, including those with minimally differentiated (M0) morphology.