•Describe the magnitude and sources of distress faced by patients with acute leukemia.•Recognize opportunities to integrate palliative care into the care of patients with acute leukemia to improve the cancer care experience and reduce patient distress. Distress screening is a recommended component of comprehensive cancer care, but the severity and sources of distress among patients with acute myeloid leukemia (AML) are unknown. To describe the etiology and severity of distress in patients with AML. We enrolled hospitalized patients with AML who were initiating induction chemotherapy, and assessed their distress levels weekly during their month-long hospitalization using the NCCN distress thermometer (DT). The DT is a validated (0-10), 11-point ordinal scale with an accompanying 39-item problem list. We analyzed data using descriptive statistics and Kruskal-Wallis tests. Twenty-six patients provided complete data. Mean age of participants was 58.7 (SD 12.2). Most had high-risk disease characteristics, including 13 (50%) being > 60 years old, 13 (50%) with high-risk cytogenetics, and 9 (31%) with relapsed disease. Distress levels were high during the first week of induction (median 5.5; IQR 2-8). The most frequent concerns were from the “emotional problems” section of the DT problem list, including: worry (77%), nervousness (62%), fears (54%), and sadness (54%). Physical problems like fatigue (69%) and sleep difficulties (58%) were also prominent. Median distress scores remained above the threshold for referral to support services (score ≥4) in weeks two and three (median 4 (1-8) and 5.5 (2-7), respectively), but improved to 2 (1-6) in week four. Nervousness and worry were significantly improved at week four (p<0.01), but sadness persisted in 32% and fatigue in 60% of patients at the fourth assessment. Problems with eating and with diarrhea were also prominent in week four, at 48% and 36% respectively. Distress is prominent among inpatients with AML who are receiving induction chemotherapy, with frequent psychological concerns upfront and persistent symptom distress in later weeks of therapy. These findings underscore the burden of unmet palliative care needs among hospitalized patients with AML.