A study was done with 27 patients who met the following criteria: (1) anemia, (2) cellular bone marrow not diagnostic of leukemia, (3) absence of underlying disease that could account for the hematologic abnormalities at time of initial study and (4) absence of iron, B(12) or folate deficiency. Of the 27 patients, 13 had ringed sideroblasts and 14 did not. Eleven patients received corticosteroids, 18 received folate, 23 pyridoxine and 12 androgens. Two partial responses occurred in the sideroblastic group and were attributed to androgen therapy in one patient and pyridoxine therapy in the other. In the nonsideroblastic group, two partial responses occurred which were attributed to prednisone therapy. Transfusions were required in 23 patients. Leukemia developed in six patients. It is concluded that currently used treatments have little effect on refractory anemia and that in most patients continuing transfusions are required. In a small percentage of patients, there is transformation to leukemia.