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Objective The study was aimed to detect bone marrow minimal residual disease (MRD) and regulatory T cell (Treg) in newly diagnosed acute leukemia (AL) and after chemotherapy, and analyze the relationship between Treg with MRD. Methods 53 cases of specimens in patients with acute leukemia were collected, and MRD and Treg were detected by multiparameter flow cytometry (FCM). From the beginning of induction chemotherapy by CR, every 3-6 months detection time, the relationship between Treg and MRD and expression of different treatment times/disease groups/risks were analyzed and compared. Results The expression of Treg in initial treatment AT patients was higher than in patients after chemotherapy and normal control (P < 0.01). There was no difference in the expression of Treg between group ANTE and group AFF (P > 0.05). High risk group was higher than low risk (P < 0.01), and there were no differences between high/low risk groups and intermediate risk group (P > 0.05). AL patients with MRD positive had a higher rate of recurrence than MRD negative patients (P < 0.01), expression of Treg in MRD positive patients was higher than that in MRD negative patients (P < 0.01). Conclusion Treg could increase in newly diagnosed leukemia patients, and it has a the higher expression when the higher grade malignancy. Treg will fall after chemotherapy and close to the normal, expression of Treg in MRD positive patient is higher than MRD negative patients. Perhaps, Treg could suppress the body immune killer for tumor cells, which has clinical significance on the prognosis, evaluation, recurrence and treatment of AL patients. [ABSTRACT FROM AUTHOR]