Anthracycline chemotherapy agents (daunorubicin, idarubicin, mitoxantrone) are highly active in AML and are an essential part initial induction therapy in those fit for intensive chemotherapy. The optimal dose of anthracycline to maximize response and survival while preserving safety is still being determined. For daunorubicin, a Phase III randomized study of younger patients ages 17 to 60 years with AML demonstrated that standard dose cytarabine 100 mg/m2 daily for 7 days in combination with daunorubicin 90 mg/m2 daily for 3 days was superior to daunorubicin 45 mg/m2 daily for 3 days with improved complete remission rates (70.6% vs. 57.3%, p<0.001) and median overall survival (23.7 vs. 15.7 months, p=0.003). Toxicity was not significantly different between the two groups. A similar Phase III study in AML patients 60 years of age or older compared daunorubicin 45 mg/m2 to 90 mg/m2 for 3 days in combination with cytarabine 200 mg/m2 daily for 7 days. Although the complete remission rate was higher in patients receiving the 90 mg/m2 daunorubicin dose (64% vs 54%, p=0.002), no difference was seen in survival. Notably, patients aged 60-65 years receiving higher daunorubicin dose had superior complete remission rates, event-free survival and overall survival. To date, no head-to-head comparisons of daunorubicin at 60 mg/m2 versus 90 mg/m2 have been published.