Patients with acute myeloid leukemia (AML) may present with early complications from sepsis or leukemic infiltration. Benefits from early in-intensive care unit (ICU) hematological management was evaluated in 42 adults with newly diagnosed AML with hematological risk of early death (age 46 years, French-American-British [FAB] M4/5 58%, leukocytes 103 × 10(9)/L) first admitted to the ICU without immediate life support (early-ICU). Controls were 42 patients primarily admitted to hematology wards, matched for age, leukocytes and FAB subtype. Twenty (47.6%) control patients were subsequently admitted to the ICU (late-ICU). Late-ICU patients presented with increased respiratory and cardiac rates, decreased oxygen saturation (SpO(2)) and blood pressure, at hospital admission. Late-ICU admission resulted in increased use of mechanical ventilation (60% vs. 33%) and vasopressors (60% vs. 16%), longer ICU stay (9 [6-25] vs. 5 [2-9] days) and decreased ICU survival (65% vs. 79%). Direct admission to the ICU of patients with high-risk AML with physiological disturbances but no organ dysfunction is associated with improved outcomes.