Historically, hospice has been a poor option for patients with end-stage hematologic malignancies, largely due to the need for regular transfusions to sustain life near the end, and to a lesser extent the treatment of curable emergent infections. In many cases, hospice is a viable and favorable option for patients with solid tumors who are out of treatment options yet have many months to live. For patients with hematologic malignancies with fewer than 6 months to live, although tens of transfusions may be required, they may have a relatively good quality of life when those transfusions are provided. I present a long-term approach to this unique population using an outpatient approach with transition to hospice. The needs of this population are markedly different from the published recommendations regarding patients with solid tumors who are either out of treatment options or have progressive disease.