Despite advancements in treatment, the prognosis for elderly AML patients remains poor. We conducted a retrospective study involving 307 consecutive AML patients, including 71 who underwent haploidentical hematopoietic cell transplantation (Haplo) and 236 who received chemotherapy (Chemo) only. Propensity score matching with 1:1 ratio was performed to balance the groups based on age at treatment initiation, gender, and European Leukemia Net (ELN) 2022 risk classification. 69 case-controlled pairs in the Haplo and Chemo group were analyzed after matching. The two groups were comparable concerning therapy prior to complete remission and 72.5% of patients in the Haplo group received reduced-intensity conditioning. Haplo was associated with a significant survival advantage over Chemo, with a 1-year OS of 77.9% (95% confidence interval(CI), 65.5-86.3, p = 0.001) versus 62.0% (95% CI, 47.9-73.2, p = 0.009). A significanly higher 1-year LFS of 74.1% (95% CI, 61.5-83.1) was also observed compared with 42.0% (95% CI, 29.3-54.0) in the chemotherapy group (p < 0.0001). The survival advantage was majorly due to a significantly reduced relapse incidence (Haplo: 16.5% (95% CI, 8.7-26.5) vs Chemo: 56.6% (95% CI, 42.9-68.2)). The 1-year non-relapse mortality was 9.4% (95% CI, 3.8-18.2) in the Haplo group. To conclude, haploidentical HCT showed superior outcomes to chemotherapy alone and might be recommended to AML patients 55 years or older eligible for transplant in future practice.