Three cases of primary myelodysplastic syndrome (MDS) associated with
myelofibrosis were initially diagnosed as refractory anemia by the pre
sence of bicytopenia or pancytopenia and having normo- or hypercellula
r marrow with dysplastic features. The bane marrow aspiration of these
patients showed dry tap a few months after admission, or on admission
. Their bone marrow biopsy specimens revealed various grades of increa
sed formation of reticulin fibers. One patient entered into complete r
emission in response to metenolone, while the other two patients died
of cerebral hemorrhage several months after admission. These results i
ndicate that this disease should be classified as a distinct subgroup
of MDS.