Acute myeloid leukemia (AML) is typically a disease affecting older people, and there are increasing numbers of elderly AML patients due to ageing populations; however, this group is often discounted from participating in clinical trials and receiving intensive, potentially curative therapy. Elderly AML patients were discussed by Alan Burnett, MD, FRCP, of Cardiff University, Cardiff, UK, within the optimization of standard treatments for AML session at the 1st International Workshop on Acute Leukemias (iwAL), held in St. Pete Beach, FL. Here, Prof. Burnett discusses his presentation with Wolfgang Hiddemann, MD, PhD, of Ludwig-Maximilian University of Munich, Munich, Germany, Laura Cicconi, MD, of the University of Rome Tor Vergata, Rome, Italy, and Klaus Metzeler, MD, of LMU-University Hospital Munich, Munich, Germany. The group discuss the unmet need in this growing population, questioning why certain elderly patients cannot receive intensive chemotherapy and achieve remission. This discussion was recorded at iwAL 2018.