Background: SCT is a potential curative option for rAML. However, many rAML patients (pts) do not receive SCT due to death or failure to achieve remission. This analysis examined the impact of remission and SCT on mortality in elderly rAML pts. Methods: rAML pts aged 66-75 years (y) were identified by medical claims associated with ICD-9 code 205.02 in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2009-2014). Pts were categorized depending on whether they had remission post-rAML (ICD-9 code 205.01) and were followed from relapse to the earliest of death, SCT, or end of follow-up. SCT rates by remission status were estimated after adjusting for the competing risk of death. Post-rAML overall survival (OS) was assessed using the Kaplan-Meier method comparing SCT and non-SCT pts by remission status. Results: 474 rAML pts (median age, 70 y, median follow up, 4.4 mo) were included. SCT rates were higher in the remission (14.4%) vs non-remission pts (4.5%; Table). Independent of SCT status, median OS was higher in the remission vs non-remission pts (10.9 vs 2.5 mo, log rank P< .001). Median OS was higher in SCT vs non-SCT pts (16.3 vs 4.2 mo, log rank P< .001) regardless of remission status. Post-rAML OS was highest for pts in remission who also had a SCT. Conclusions: While both remission and SCT independently reduce mortality, SCT is important in reducing mortality among rAML pts regardless of remission status. Therapies that improve both remission and SCT rates may therefore provide greater survival gains in this high unmet need population.