23 patients with aregenerative anemia from the hematology section at the Karolinska Hospital were followed. The patients were divided into 3 groups; those with a hypocellular marrow, those with a hypercellular marrow and those with marrow fibrosis. Mostof the patients with hypocellular marrow had granulocytopenia, but no thrombocytopenia, and they did not develop leukemia. The group of patients with hypercellular marrow had no granulocytopenia, but thrombocytopenia and sideroblastosis, and they often developed leukemia. It seems justified to look upon aregenerative anemia with hypercellular marrow and sideroblastosis as a preleukemic state. The change in cellular metabolism (sideroblastosis, possible prolongation of generation time) preceded the leukemia by several years, but the cellular differentiation appeared normal prior to leukemia development. The sideroblastosis may be related to the early changes in iron metabolism previously demonstrated in cancer patients.

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