In order to investigate the clinical characteristics and management of elderly patients with acute leukemia, we retrospectively analyzed treatment results for 61 acute leukemia patients aged 65 years or more (median age 72) admitted to our department between October 1995 and September 2006. There were 6 elderly patients with ALL (acute lymphocytic leukemia) and 55 patients with AML (acute myelogenous leukemia). Among them, 51 patients could receive chemotherapy, but 10 patients received symptomatic therapy only. Complete remission was achieved in 50% of 46 patients who received chemotherapy, and median overall survival was 237 days. We analyzed treatment results for AML patients who underwent chemotherapy as follows. The intensive chemotherapy group and the de novo leukemia group showed a significantly higher CR rate and longer survival. No differences were found in karyotype, performance status or complications. Intensive chemotherapy was effective for 65-74-year-old patients with de novo AML. In future, we consider that the prognosis for elderly patients with acute leukemia will improve, if made-to-order treatment is given, depending on evidence-based stratification of patients with organs having low reserve capacity.