【Abstract】 Objective To study the effect of total trans retinoic acid （ATRA）combined with arsenite （ATO）on NPM1 positive elderly patients with acute nonpromyelocytic leukemiaAPL AML）.Methods 76 elderly AML patients with NPM1 admitted to our hospital from February 2012 to February 2017 were selected as study subjects. According to the random number table method, they were divided into observation group and control group, 38 cases in each group. The control group was treated with lowdose cytarabine (LDAC)chemotherapy. The observation group was treated with ATRA and ATO and LDAC chemotherapy. The early mortality rate, complete remission rate, relapse rate were compared between the two groups. Adverse reactions and 1 year survival rates were compared.Results The complete remission rate of the observation group was, significantly higher than that of the control group. The recurrence rate of the observation group was significantly lower than the control group. The difference between the groups was statistically significant (all P< 005). The incidence of liver function injury, gastrointestinal reaction and headache in the observation group were not obvious, compared with the control group, and the difference between the groups was not statistically significant (all P＞005). The 1year survival rate of the observation group (3684%) was higher than that of the control group (1579%). The difference between the groups was statistically significant (P< 005).Conclusion ATRA, in combination with ATO and LDAC is effective in the treatment of NPM1positive elderly patients with acute nonpromyelocytic leukemia, which can effectively provide complete remission rate, reduce the recurrence rate and extend the OS for 1 year, which is of high safety and worthy of further clinical study.