Fifteen AML patients with first or subsequent relapse and three patients with primary refractory disease were treated with a combination of idarubicin (8 mg/m2, three doses), cytosine arabinoside (100 mg/m2, six doses) and etoposide (100 mg/m2, five doses) for induction of a subsequent remission. Six patients (33%) achieved a subsequent remission, two patients (11%) a partial remission, eight patients (45%) were treatment failures and two patients 11 % died during induction therapy due to infectious complications. One of the patients died in CR during autologous bone marrow transplantation, whereas the remaining five complete responders suffered from a subsequent relapse (three of five after bone marrow transplantation, two of five after further consolidation therapy) with a median remission duration of 254 days. Major non-hematological toxicity was due to infectious complications, while no severe cardiac side effects were found despite the fact that most patients had been heavily pretreated with anthracyclines. Hematotoxicity was profound with grade IV (WHO criteria) toxicity in all cases under study with a median duration of critical granulocytopenia of 22 days and of critical thrombocytopenia of 20 days during the first induction course.