To observe the biological characteristic and the prognoses in patients with acute erythroleukemia (AEL). The results of 167 patients with newly diagnosed AEL, from January 2004 and June 2014 in the department of Hematology, Shandong Province Chinese Medicine Hospital, were reviewed by morphology, immunology, cytogenetics, molecular biology. Flow cytometry analysis indicated that CD13 (96.1 %), CD33 (95.1 %), CD117 (87.4 %) and CD34 (79.4 %) were highly expressed in AEL. 56 of 148 (37.8 %) AEL patients had a variety of cytogenetic abnormalities, 27 of 148 (18.2 %) patients were complex karyotype (abnormal involving 3 or more chromosomes), the abnormalities of chromosomes 3, 5, 7 and 8 were more frequently involved and the most common one was +8, accounting for 35.7 % of all abnormal karyotype, followed by 5q- (17.9 %). Mutation analysis showed CEBPA mutation ratio of AEL patients was 44.0 % (11/25), that of NPM1as 15.4 % (4/26). Initial induced remission rate of AEL was 56.6 % (30/53), compared by 33.3 % (4/12) of MDSM6. Survival analysis was shown that the overall survival in female was better than that in male (P = 0.047). The overall survival time of transplantation group was significantly longer than chemotherapy group (P = 0.000). The OS of 13-39 years old group was the best, 40-49 years old group took second place, >50 years old group appeared to be the worst. Patients with AML-M-6 had dysplasia in varying degrees in granulocyte, erythrocyte and megakaryocyte series. Periodic acid-Shiff reaction staining in polychromatic erythroblast and ortho-chromatic erythroblast had a specificity in the diagnosis of AEL. AEL had its own unique biological features, and allogeneic hematopoietic stem cell transplantation could significantly improve its poor prognosis.