Ara-C in combination with anthracycline antibiotics remains the classic induction regimen for primary AML, which has evolved considerably in the last four decades and has significantly improved patient survival. The metabolite of IDA in vivo, alcoholic 4-demethoxy erythromycin (IDAol), has the same antitumor activity as IDA, and the clearance time in vivo is much longer than that of IDA, and can cross the blood-brain barrier and placenta. Thus, the antitumor activity of IDA is stronger than other anthracyclines such as erythromycin. Berman et al. treated 130 primary AML cases (aged 16-60 years) with IA and two induction regimens of erythromycin (DNR)/Ara-C (DA), respectively, and the CR rate (80%) and 2.5-year overall survival (OS) (19.7 months) in the IA group were significantly higher than those in the DA group (CR 58%; OS 13.5 months). There are also many domestic literature reporting the efficacy of IA for primary, relapsed and refractory AML, with CR rates of 60%-87% for primary AML and 45%-60% for relapsed and refractory AML, but it was found that the disease often relapsed within a short period of time. We found that the doses of IDA used in China were all 6-10 mgm-2d-1´ 3 d or a total of 30 mg, which is significantly lower than the standard dose abroad, i.e. 12 mgm-2d-1´ 3 d. The British AML Collaborative Group used IA for AML and had a 5-year survival rate of 13%. Domestic authors suggest that the unsatisfactory efficacy may be partly related to the low amount of IDA. In order to strive to achieve CR after the first induction treatment, improve the overall CR rate and obtain long-term survival, so we recently used standard dose of IDA combined with Ara-C continuous intravenous drip treatment of AML, the results showed satisfactory clinical efficacy. 1 course of IA chemotherapy after the total effective rate of 92.9%, the overall CR rate of 85.7%, including primary AML CR rate of up to 90.0%, refractory, relapsed AML CR rate of 75.0%. The CR rate for relapsed AML was 75.0%, three patients with chromosomal abnormalities had achieved cytogenetic remission, and the FISH test inv(16) decreased from 97.2% to 0.6% before chemotherapy, and t(8, 21) turned negative. These results fully demonstrate the high efficacy of the standard dose standard usage IA regimen with high clearance of leukemic cells and tolerated by all patients, including one 70-year-old refractory patient with no early death. 12 CR patients had no disease relapse within 6 months and only one relapse 10 months after CR, and this patient had high leukocyte AML and LDH was still significantly LDH despite achieving CR after chemotherapy Like other units in China, we used lower dose IDA combined with Ara-C for AML before December 2004 and reported on refractory, relapsed acute leukemia, 10 patients with AML (5 each with M1 and M2) had a CR rate of 45% after 2 courses of IA induction therapy. However, there were 3 cases of relapse within 6 months and 1 treatment-related death occurred. Compared with the two IDA doses, we found that the CR rate of 1 course of standard dose IDA/Ara-C was significantly higher than that of 2 courses of lower dose IDA/Ara-C, and early relapse was also reduced. One M5 patient stopped chemotherapy for 8 months after chemotherapy due to tuberculosis infection, but the bone marrow reached CCR, which is sufficient to confirm the persistence of IA effect. The most important toxic side effect of IDA is myelosuppression, and the duration of myelosuppression after chemotherapy with lower doses of IDA/Ara-C in our hospital before 2004 12 was 10-23 d (mean 16 d), and all patients developed infection after chemotherapy, and one of them died due to infection. In contrast, the median duration of neutrophil <0.5×109/L and platelet <20×109/L after standard dose IDA was 17 d and 18 d, respectively. 13 cases (92.9%) developed infections due to granulocyte deficiency, and all patients' infections were effectively controlled, 12 of which were rapidly controlled after hematocrit recovery, and one case with fever for 5 months was diagnosed with combined liver and spleen tuberculosis, and anti-tuberculosis The body temperature was normalized after 3 months of anti-tuberculosis treatment. Therefore, the standard dose of IDA did not increase the incidence of lethal infections, nor did uncontrollable infections occur. The extramedullary toxicity of IDA was low, and one case (7.1%) of hepatic impairment occurred in this group, and the ALT returned to normal after discontinuation of the drug, which was consistent with the literature, while another patient with AML with combined hepatitis C had received 2 courses of CAG chemotherapy before receiving IA treatment, and the ALT did not appear abnormal at the end of IA chemotherapy, and died of liver failure 1 month later due to a significant increase in ALT and total bilirubin, and eventually death was considered to be related to hepatitis activity. Gastrointestinal reactions were effectively controlled by drugs in all patients, and there were no cardiac or renal function or neurotoxic reactions caused or aggravated by drugs. IDA prolongs disease-free survival in addition to achieving a high CR rate. The median CCR time in our group of 12 patients with CCR was 6+ months, and the standard dose of IDA for AML initially showed better long-term efficacy, but our group did not show the superiority of its long-term efficacy because of the short follow-up period. This remains to be further clinical observation. Among the 11 surviving CR patients in our group, 3 have received auto-HSCT, 3 have received allo-HSCT, and 5 have discontinued chemotherapy (6 to 13 months of treatment) except for 1 case that relapsed and received chemotherapy again; 2 cases are receiving high-dose chemotherapy in preparation for auto-HSCT, and the other 3 cases have used conventional dose chemotherapy and discontinued chemotherapy for various reasons. This group of cases illustrates that we can treat AML with standard-dose IDA/Ara-C and strive to achieve CR in 1 course to maximize the clearance of leukemic cells, followed by 1-2 high-dose chemotherapy followed by auto-HSCT or direct allo-HSCT in order to obtain long-term survival, shorten the number of chemotherapy sessions and improve the quality of patients' survival. In summary, standard-dose IDA combined with Ara-C 24-hour continuous intravenous drip therapy for primary, relapsed, and refractory AML has a high CR rate over 1 course, with some patients having achieved cytogenetic remission with durable CR and no early relapse without increased drug toxic effects. Young and even elderly patients can tolerate it, and all have a post-chemotherapy physical status of grade 0-1, and create the time for high-dose chemotherapy and auto-HSCT and allo-HSCT, thus aiming to clear MRD from the body in a short period of time and achieve long-term survival.