胞嘧啶和蒽环类药物联合疗法（7 + 3方案）是成人急性髓细胞性白血病（AML）诱导化疗的标准治疗。尽管这种高强度疗法能达到较高的有效率，但对于年长或虚弱患者来说，副作用较高。用于高危骨髓增生异常综合征的低甲基化剂在新诊断的年老患者中的生存时间较传统治疗更长。我们总结了关于使用低甲基化剂（氮芥胞苷和地西他滨）进行新诊断AML诱导治疗的最新信息。对于不适合高强度疗法的未治疗患者，一项III期试验证实将高选择性BCL2抑制剂维利兹洛克赞加入氮芥胞苷治疗可带来生存获益。全国综合癌症网络指南建议对于AML患有TP53基因突变和骨髓增生异常综合征细胞遗传学特征的有不良风险的患者，可考虑给予氮芥胞苷或地西他滨联合维利兹洛克赞治疗。未来的研究应评估将这种联合疗法定位为适宜接受造血干细胞移植的年轻患者的诱导治疗。尽管缺乏随机试验，倾向得分匹配分析显示氮芥胞苷联合治疗和强化化疗具有可比的预后。考虑到将氮芥胞苷纳入双联疗法的可行性，应考虑进行三联疗法的研究。

Cytarabine and anthracycline combination therapy (7 + 3 regimen) is the standard care for induction chemotherapy in adult patients with acute myeloid leukemia (AML). Although this intensive regimen achieves a high response rate, it is highly toxic, especially in elderly or frail patients. Hypomethylating agents approved initially for high-risk myelodysplastic syndrome had longer survival times than conventional care in elderly patients with newly diagnosed AML.We summarize the latest information regarding induction therapy using hypomethylating agents (azacitidine and decitabine) for newly diagnosed AML.For untreated patients ineligible for an intensive regimen, a phase III trial exhibited the survival benefit of adding the highly selective BCL2 inhibitor venetoclax to azacitidine. The National Comprehensive Cancer Network guidelines recommend azacitidine or decitabine plus venetoclax as an option for patients with poor-risk AML, including those with TP53 mutations and AML with the cytogenetic features of myelodysplastic syndrome. Future studies should evaluate positioning this combination as an induction therapy for younger patients eligible for hematopoietic stem cell transplantation. Without randomized trials, propensity score matching analysis suggested a comparable prognosis between azacitidine combination and intensive chemotherapy. Considering the feasibility of a doublet regimen incorporating azacitidine, a triplet regimen should be examined.