A 79-year-old woman with a history of hypertension, heart failure with ejection fraction of 45%, and rheumatoid arthritis managed with methotrexate is diagnosed with adverse-risk cytogenetics acute myeloid leukemia (AML). Laboratory findings are notable for a white blood cell (WBC) count of 2000/µL with 25% blasts, hemoglobin 8.0 g/dL, platelet count 76 × 10³/µL, serum creatinine 0.8 mg/dL, alanine aminotransferase (ALT) 20 U/L, and aspartate aminotransferase (AST) 22 IU/L. Despite some fatigue and dyspnea on exertion, she is ambulatory and able to take care of her household chores.