Agnogenic myeloid metaplasia is a disorder of unknown etiology categorized as one of the myeloproliferative states. The disease is characterized by massive-to-moderate splenomegaly, a leukoerythroblastic blood picture with teardrop poikilocytes, and in most patients a fibrotic bone marrow.
Recently, as reported in the Archives of Internal Medicine, Silverstein and associates1 studied 137 patients with this disorder retrospectively. Two groups of patients were categorized. The first was a group of 48 asymptomatic patients who were observed during a 50-month period and required no specific therapy for the disease. The probability of survival in these patients was only 58% of the expected normal. A high incidence of degenerative vascular disease was noted in these patients. The second group was composed of 89 patients who had disease symptoms of anemia, thrombopenia, or pain related to the huge spleen or splenic infarction. Medical regimens involving various combinations of androgens, steroids, busulfan, transfusions, and