Repeated bone marrow biopsies of 12 patients with chronic myelocytic leukemia (CML) and 13 patients with idiopathic myelofibrosis (IMF) were compared. The amount of cellularity, the composition of the cell population, and the stromal changes were assessed. Both diseases were divided into four stages, each with a consistent morphologic pattern. In CML, Stage 1 presented a tremendous increase in granulocytes and a drop of the erythroid series; Stage 2 showed a shift to myelocytes and a moderate increase of blasts; in Stage 3 there was a strong increase of blasts and the reappearance of red cells; and in Stage 4 hematopoietic cells disappeared with metastases of abnormal blasts to many organs. The stroma showed a progressive fibrosis so that by Stage 4 there was a totally fibrotic marrow. With IMF, Stage 1 presented a dysharmonic trilinear proliferation; in Stage 2 there was a maximum of cellularity, which remained trilinear; in Stage 3 there was a decrease of hematopoietic cells; and in Stage 4 these cells disappeared, but hematopoietic cells in dilated sinusoids of the empty marrow became apparent. The stroma showed a progressive fibrosis, ending by Stage 4 in a totally fibrotic marrow indistinguishable from the similar stage of CML. Careful analysis of the bone marrow biopsy findings permitted the stage of the disease and hence the prognosis to be determined; Stage 3 for CML means death within a short period of time. In clinically “acute” myelocytic leukemia, the biopsy helps to make the distinction between Stage 3 of an unsuspected CML and acute myelocytic leukemia.