Abstract: Objective To investigate the clinical efficacy of different doses of anthracycline idarubicin in the induction treatment of acute myeloid leukemia（AML）for adults aged less than 60. Methods A total of 265 young AML patients（14~59 years old）were diagnosed at our center from June 2015 to December 2019. We retrospectively reviewed 239 patients treated with the regimen of idarubicin combined with cytarabine（IA 3+7）,focusing on complete remission（CR）rate,recurrence and long-term survival in patients with different prognostic risk groups. Results After the first induction therapy,61（65.6%）and 103（70.6%） patients in the IDA 8 mg/m² group and the IDA 10~12 mg/m² group obtained morphological CR（P=0.475）,of which 26 patients（42.6%）in the IDA 8 mg/m² group and 64 patients（62.1%）in the IDA 10~12 mg/m² group had minimal residual disease（MRD）negativity. The 3-year cumulative incidence of relapse（CIR） was 45.1%（95% CI：34.1%~57.8%）in the IDA 8 mg/m² group and 49.6% （95% CI：40.7%~59.3%） in the IDA 10~12 mg/m² group（P=0.469）. The 3-year overall survival（OS）rate was lower in the IDA 8 mg/m² group [34.6%（95% CI：24.9%~44.4%）] than in the IDA 10~12 mg/m² group [46.6%（95% CI：38.2%~54.6%）] （P=0.038）. For intermediate-risk patients,the 3-year OS rate for patients in the IDA 8 mg/m² group was 31.5%（95% CI：18.9%~45.0%）,which was significantly lower than that in the IDA 10~12 mg/m² group [43.7%（95% CI：32.3%~54.6%）] （P=0.043）. The 3-year event-free survival（EFS） rate in the IDA 8 mg/m² group and the IDA 10~12 mg/m² group were 32.0% （95% CI：22.7%~41.6%）and 37.0%（95% CI：29.2%~44.8%）respectively（P=0.319）. For intermediate-risk patients, there was a lower trend of the 3-year EFS rate in the IDA 8 mg/m² group [25.4%（95% CI：14.0%~38.4%）] than in the IDA 10~12 mg/m² group [33.3%（95% CI：23.0%~44.0%）] （P=0.107）. There were no significant differences in the 3-year OS rate and 3-year EFS rate between the favourable risk group and the adverse risk group. Conclusion For young adult patients with AML,the induction therapy with IA (3+7) regimen based on idarubicin 10~12 mg•m^-2•d^-1×3 d could achieve higher immunological remission and better long-term survival,especially for patients with intermediate risk according to 2017 ELN risk stratification.

Key words: Acute myeloid leukemia, IDA, ELN risk stratification, Induction chemotherapy, Minimal residual disease