The clinical significance of serum ribonuclease (RNase) assay in acute leukemia was studied. Serum RNases were assayed by the method of Akagi et al. with slight modifications in the serum samples obtained from 50 cases of healthy subjects, 55 cases of acute leukemia before therapy, 18 chronic myelocytic leukemia before therapy, 13 chronic myelocytic leukemia under treatment and 20 reactive leukocytosis. The ratio of acid RNase to alkaline RNase activities (Ac/Al ratio) was statistically increased in acute promyelocytic leukemia, acute myeloblastic leukemia [M2], acute myelocytic leukemia and erythroleukemia (leukemic stage) compared with those in healthy subjects (P less than 0.001). All cases of acute promyelocytic leukemia and most of the acute myeloblastic leukemia [M2], acute myelomonocytic leukemia and erythroleukemia cases had an Ac/Al ratio of above 1.0. In remission of acute leukemia, it is noteworthy that acid and alkaline activities showed no substantial difference from those of healthy subjects. While, on relapse of acute leukemia cases, showing Ac/Al ratio above 1.0 in pretreatment state, Ac/Al ratio increased to above 1.0. Thus, the assay of serum RNases and the calculation of Ac/Al ratio might be an additional method for diagnosing acute leukemia and for assessing their remission and recurrence in some type of acute leukemia.