Acute myeloid leukemia (AML) has a high recurrence rate, high case fatality rate and drug resistance, which are major problems to be solved and a research hotspot. A number of researches confirmed that exosome-derived microRNA (miRNA) plays an important role in the disease process, such as the regulation of bone marrow microenvironment, formation of tumor blood vessels in AML, and participating in the occurrence of drug resistance. So for exosome-derived miRNA related researches in AML provide the new research direction to improve the prognosis of patients with AML and overcome drug resistance. The article intends to introduce the related role of exosome-derived miRNA in AML and the drug resistance mechanism of AML mediated by them.