Objective To investigate the distribution and prognosis of elderly patients with acute leukemia. Methods Clinical data of 340 untreated acute leukemia patients with age over 60 years admitted in our hospital from September 2009 to May 2013 were enrolled in this study. Their onset age, prognostic risk factors, therapy and survival were retrospectively analyzed. Results In this cohort of patients, their median onset age was 68 years. There were 24 patients (7.06%) with acute lymphoblastic leukemia (ALL). In 314 patients with acute myeloblastic leukemia (AML), there were 250 patients (79.62%) with de novo AML, and 9 patients with acute promyelocytic leukemia (APL). There were 34 cases (14.11%) of de novo AML (non APL) having good prognosis based on cytogenetic and molecular biology, and 61 cases having unfavourable prognosis. The proportion of good prognosis was decreased along with the increase of age, while that of unfavourable prognosis was elevated. Among the 93 patients with survival data, 85 of them received chemotherapy. Age also exerted obvious effect on the complete remission (CR) rate and total survival rate. Patients who gained CR after chemotherapy had longer survival than those without CR. Conclusion The prognosis of elderly patients with acute leukemia is poor. How to improve the total survival rate is still a difficult task.