Twenty-one patients with previously untreated acute leukemia were treated with a combination chemotherapy of 120–200 mg/m2 of aclacinomycin A (ACM-A) in five divided daily doses and behenoyl-arabinofuranosylcytosine (BH-AC) 200–250 mg/m2 for 7 days at Saitama Cancer Center between April 1980 and July 1983. Complete remission was obtained in 12 of 21 patients (57.1%; M1 0/1, M2 10/10, M3 0/2, M4 1/3, leukemic transformation from sideroblastic anemia 0/1, refractory anemia with excess of blasts in transformation 1/2, chronic myelomonocytic leukemia 0/1). Seven of 9 patients who failed to have complete remission were crossed over to a combination chemotherapy of daunorubicin (DNR) plus BH-AC or cytosine arabinoside (ara-C), or single DNR for patients with M3, yielding complete remission in 5 patients. Seven patients received a total cumulative dose of more than 600 mg/m2 of ACM-A. The maximum dose given was 2,000 mg/m2. No congestive heart failure has yet been experienced. The median survival time was 12 months. These results have demonstrated that a combination of ACM-A and BH-AC shows almost equivalent activity with that of a standard induction therapy consisting of DNR plus ara-C. In addition, it was suggested that ACM-A plus BH-AC could be incorporated into reinforcement therapy because of supposedly less cardiac toxic