Used primarily as an antineoplastic agent in the treatment of acute leukemias, particularly acute myeloid leukemia (AML). It functions by intercalating into DNA and inhibiting topoisomerase II, which leads to DNA strand breaks and ultimately induces apoptosis in rapidly dividing cancer cells. Amsacrine hydrochloride is especially considered in induction therapy regimens for patients who are not responsive to or cannot tolerate other chemotherapeutic agents like anthracyclines. Its use is typically reserved for specific clinical scenarios due to its toxicity profile, including potential cardiotoxicity and myelosuppression. The compound has been studied in combination with cytarabine and other agents to improve remission rates in adult and pediatric leukemia patients.