Abstract: Objective To evaluate the therapeutic effects of chemotherapeutic regimen with pirarubicin in the management of adult high-risk acute leukemia. Methods Twenty-nine high-risk acute leukemia patients were selected as the treatment group and another 29 patients with similar pretreatment conditions as the control group. In the treatment group, 18 patients had acute non-lymphocytic leukemia (ANLL), and 8 had acute lymphocytic leukemia (ALL) and 3 had mixed leukemia, all received treatment regimens with pirarubicin+cytarabine, vincristine+pirarubicin+prednisone, Vincristine+pirarubicin+L-asparaginase (L)+prednisone or pirarubicin+cytarabine+vincristine+prednisone. Routine therapeutic regimens were adopted in the management of the control. Results In ANLL patients, the overall remission rate was significantly higher in the treatment group than in the control group (77.78% vs 44.44%, P=0.031). Paitents in the treatment group had greater marrow suppression and higher incidence of infections than the control group (P=0.012). Conclusion Regimens with pirarubicin is more effective than the routine regimens in the management of patients with high-risk ANLL and produce greater but tolerable marrow suppression.