Palliative Care for Patients with Newly Diagnosed, Relapsed, or Refractory Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, High-Risk Myelodysplastic Syndrome or High Risk Chronic Myelomonocytic Leukemia

Inclusion Criteria

• Ability to provide informed consent
• Stated willingness to comply with all study procedures and availability for the duration of the study
• Any of the following: * Patients with a new diagnosis of acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL) , high risk myelodysplastic syndrome (MDS) or high risk chronic myelomonocytic leukemia (CMML) who are age 65 and older ** New diagnosis will be defined as diagnostic bone marrow biopsy or peripheral flow cytometry within 8 weeks of enrollment ** High risk MDS defined as follows: International Prognostic Scoring System (IPSS) intermediate-2 or high-risk categories or revised IPSS scores > 3.5 ** High risk CMML defined as follows: Blasts make up 5% to 19% of the white cells in the blood, or they make up 10% to 19% of the cells in the bone marrow ** Note: Myeloproliferative neoplasms (MPN) in blast crisis is included in either AML or ALL subtype * Patients with relapsed AML, ALL , high risk MDS (defined above) or high risk CMML (defined above) ages 18 and older ** Relapse must have occurred within 8 weeks of enrollment * Patients with refractory AML, ALL, high risk MDS or high risk CMML ages 18 and older ** Refractory status must have occurred within 8 weeks of enrollment ** Refractory AML will be defined as any of the following: *** Not having achieved CR (complete response) or CRi (CR with incomplete hematologic recovery: absolute neutrophil count (ANC) < 1000 /uL or platelets < 100,000/uL) despite two lines of cytotoxic chemotherapy *** Not having achieved CR, CRi, or CRh (CR with partial hematologic recovery: ANC < 50/uL or platelets < 50,000/uL) despite three cycles of hypomethylating agent (HMA) or targeted agent monotherapy *** Not having achieved CR, CRi, or CRh despite two cycles of HMA/venetoclax *** Evidence of leukemia progression, such as elevated peripheral blast count, as defined by treating clinician, after one or more cycles of leukemia directed therapy ** Refractory ALL will be defined as not having achieved CR, CRi, or CRh after induction chemotherapy ** Refractory MDS will be defined as per the 2006 International Working Group (IWG) response criteria ** Refractory CMML will be based on the assessment/opinion of the treating investigator

Exclusion Criteria

• Participants must not have a diagnosis of acute promyelocytic leukemia (APL)