Chidamide, Venetoclax, Azacitidine, and Homoharringtonine for High-risk Fit AML

Inclusion criteria

• Newly diagnosed fit-AML patients classified per the World Health Organization (WHO) classification criteria.
• Age ranging from 18 to 60 years, no restriction on gender.
• No prior anti-AML systemic therapy after AML diagnosis; cytoreductive treatment (e.g., hydroxyurea or cytarabine at a daily dose <1.0 g) is permitted as exception.
• Estimated overall survival ≥12 weeks.
• Eastern Cooperative Oncology Group (ECOG) performance status ≤3 points.
• Renal function: calculated creatinine clearance (CrCl) ≥30 mL/min.
• Hepatic function: alanine aminotransferase (ALT) <5× upper limit of normal (ULN); total bilirubin <3× ULN.
• Able to provide written informed consent and understand as well as comply with all study-specified procedures.

Exclusion criteria

• Patients stratified as favorable-risk AML defined by NCCN Guidelines 2022, including cytogenetic aberrations: t(8;21)(q22;q22.1); RUNX1-RUNX1T1, inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11.
• Confirmed acute promyelocytic leukemia (APL). AML complicated with central nervous system (CNS) leukemia infiltration.
• Cardiac function exceeding NYHA functional class II.
• Confirmed human immunodeficiency virus (HIV) infection or other uncontrolled clinically significant comorbidities, including but not limited to:

• Uncontrolled or active systemic infection (viral, bacterial or fungal); ② Concurrent second primary malignancy requiring urgent clinical intervention.

• Patients unable to receive oral chidamide and/or venetoclax administration. 7. Known hypersensitivity to any investigational product. 8. Pregnant or breastfeeding female subjects. 9. Inability to understand or adhere to the study protocol requirements. 10.Subjects deemed unsuitable for enrollment at the investigator's discretion