Hematopoietic cell crisis: an early stage of evolving myeloid leukemia following radiation exposure

Under select radiological conditions, chronic radiation exposure elicits a high incidence of myeloproliferative disease, principally myeloid leukemia (ML), in beagles. Previously we demonstrated that for full ML expression, a four-stage preclinical sequence is required, namely (I) suppression, (II) recovery, (III) accommodation, and (IV) preleukemic transition. Within this pathological sequence, a critical early event has been identified as the acquisition of radioresistance by hematopoietic progenitors that serves to mediate a newfound regenerative hematopoietic capacity. As such, this event "sets the stage" for preleukemic progression by initiating progression from preclinical phase I to II. Due to the nature of target cell suppression, the induction of crisis, and the outgrowth of progenitors with altered phenotypes, this preleukemic event resembles the "immortalization" step of the in vitro transformation sequence following induction with either physical and chemical carcinogens. The radiological, temporal, and biological dictages governing this event have been extensively evaluated and will be discussed in light of their role in the induction and progression of chronic radiation leukemia.