We report a single center experience in treating 24 consecutive patients > or = 60 years old for aplastic anaemia (AA) with immunosuppressive therapy (IST). The main outcomes of interest were the tolerability and toxicity of IST, response rate and survival. Median age was 70 years (range 61-78). Seven patients received standard IST consisting of standard dose antithymocyteglobulin (ATG) with or without ciclosporin (CsA), and 17 patients received attenuated IST consisting of at least a 50% dose reduction of ATG with CsA or CsA alone. Six patients (25%) had early deaths, mostly due to infection. Early mortality appeared higher in the standard IST group although this was not statistically significant (43% vs. 18%, P = 0.4). The 2-year cumulative incidence of response was 42% [95% confidence interval (CI) 26-69%]. Responders had significantly better survival than non-responders (P = 0.0002). The 3-year probability of overall survival was 49% (95% CI 27-68%). Moderate or severe co-morbidities (P = 0.03) as determined by Charlson Co-morbidity Index and very severe AA (P = 0.007) were associated with significantly inferior overall survival while age was not. Nine out of 14 evaluable patients in the attenuated IST group had durable responses to treatment, suggesting that patients not suitable for standard IST can still benefit from attenuated IST.