Patient description: The patient is a 34-year-old African American man with the known history of Sickle cell disease comes to the clinic with severe bone pain. The patient had severe pain in his lower back that radiated to both thighs scored 9 out of 10. The patient has had positive history of sickle cell crises since childhood. He also had the same symptoms in past two weeks treated with oxycodone which was not beneficial to his pain. His PCP sent him to the emergency department to receive intra venous pain modulators. The patient is afebrile within the normal blood pressure. No splenomegaly was detected in the physical exam. He has no positive history of drug allergy. He won't smoke or uses any illicit drugs. The lab study is as bellow: Hgb: 8 g/dl WBC: 10000 /mm3 Plt: 300000 /ml MCV: 106 fL Hemoglobine electrophoresis: 91% HbS 6%HbF 3%HbA2 AST: 22 U/L ALT: 43 U/L Alk P: 53 U/L Ferritin: 1200 ng/ml

Clinical trial eligibility criteria: eligible ages (years): 18.0-100.0,  Acute Myeloid Leukemia Written informed consent 2. Patients who present with one of the following (except acute promyelocytic leukemia) De novo or secondary AML patients who are non-fit for standard induction therapy (see below) Relapsed or refractory AML patients following at least 1 line of prior therapies (see below) 3. Ex vivo sensitivity testing performed to assess venetoclax sensitivity 1. Validation cohort: All participants are treated with venetoclax+azacitidine irrespective of the ex vivo screening results. 2. Study cohort: Only the participants exhibiting ex vivo sensitivity to venetoclax are included to study therapy. 4. Participant must have ECOG Performance status ≤ 2 for participants ≥ 75 years of age OR ≤ 3 for participants ≥ 18 to 74 years of age 5. Leukocyte count < 25 x10E9/l. Hydroxyurea use is permitted to meet this criterion. 6. Participant must have adequate renal function as demonstrated by a calculated creatinine clearance ≥ 30 mL/min; determined by the Cockcroft Gault formula. 7. Participant must have adequate liver function as demonstrated by 1. alanine aminotransferase (ALT) ≤ 4.0 × ULN 2. bilirubin ≤ 1.5 × ULN 8. Specific for participants non-fit for standard chemotherapy Participant must be: ≥ 70 years of age OR ≥ 18 to 69 years of age and ineligible for intensive chemotherapy meeting at least one of the following Clinically significant comorbidities, reflected at least 1 of Left ventricular ejection fraction (LVEF) < 50% Lung diffusion capacity for carbon monoxide (DLCO) ≤ 65% of expected Forced expiratory volume in 1 second (FEV1) ≤ 65% of expected Chronic stable angina or congestive heart failure controlled with medication Alanine aminotransferase (ALT) 3.0-4.0 × ULN Other contraindication(s) to anthracycline therapy (must be documented)  Participant has acute promyelocytic leukemia (APL) 2. The leukemic cell content (blast percentage) in bone marrow/peripheral blood (depending which is used for drug sensitivity testing) is ≤ 10 % 3. ECOG >3 (see also 4) 4. Participant has known CNS involvement with AML (note: CSF or radiological investigations are not required without clinical suspicion) 5. Participant with known HIV infection or active hepatitis B virus (HBV), or hepatitis C virus (HCV) infection that is not controlled with anti-viral medication. 6. Participant has cardiovascular disability status of New York Heart Association Class ≥ 2. Class 2 is defined as cardiac disease in which participants are comfortable at rest but ordinary physical activity results in palpitations, fatigue, dyspnea, or anginal pain. 7. Evidence of clinically significant condition(s) that in the opinion of the investigator would adversely affect his/her participation in this study (including but not limited to): 1. Participant has a chronic respiratory disease that requires continuous oxygen use 2. Systemic uncontrolled infection requiring therapy (viral, bacterial or fungal) 3. Malabsorption syndrome or other condition that precludes enteral route of administration. 4. Uncontrolled GVHD. 8. Participant has a history of other malignancies prior to study entry, with the exception of previous malignancy treated with curative intent