Objective To compare the clinical manifestations, response to treatment and long-term survival of acute promyelocytic leukemia(APL) between elderly and young patients, and to determine the efficacy and safety of the all-trans retinoic acid combining arsenic trioxide and chemotherapy for the elderly. Methods Clinical data of 247 patients with APL admitted in our institute from 1992 to 2010 were collected, and retrospectively studied to compare their clinical manifestations, remission, relapse, mortality and survival rate between elderly (with an age of ≥55, n＝21) and non-elderly groups (with an age of ＜55, n＝226). Results (1) There was no significant difference between the elderly and non-elderly APL patients in gender, white blood cells, hemoglobin, platelets, disseminated intravascular coagulation (DIC), central nervous system leukemia (CNSL), and immunophenotypes of CD56 and CD117. (2) The rate of complete remission (CR) (100.0% vs 95.1%) and mortality in induction therapy (0.0% vs 4.4%) were a little bit better in the elderly group than the non-elderly group, though without significant difference (P＝0.301, P＝0.325). But the relapse rate (19.0% vs 16.3%) and death in CR (4.8% vs 1.9%) were higher in elderly APL than in non-elderly group, and there was no significant difference either between them (P＝0.744, P＝0.095). (3) No obvious difference was found in 4-year, 6-year, and 7-year overall survival rate and event-free survival rates between elderly and non-elderly APL (P＞0.05). Conclusions There is no significant difference between the elderly and non-elderly APL in clinical features, response to treatment and long-term survival. So, the efficacy and safety of current treatment are guaranteed for elderly APL patients.