Chronic myelogenous leukemia as a model for the genetic basis of cancer

CML has provided a model for the genetic basis of human neoplasia. Since 1960 with the discovery of the Ph chromosome, study of this disease has provided a conceptual basis for viewing cancer as a clonal disorder occurring at the stem cell level and associated with intrinsic genetic defects which contribute to abnormal growth regulation. Although several oncogenes have been identified through the study of tumor-producing retroviruses in animals, discovery of the BCR/ABL translocation, the altered 8.5 kb BCR/ABL transcript, and the hybrid BCR/ABL P210 protein with enhanced tyrosine kinase activity has provided one of the first examples of a human neoplasm in which structural alterations in a normal cellular gene might lead to malignant transformation. However, it is likely that P210 is necessary but not sufficient for the full spectrum of malignant behavior observed in this disease. Investigation of the molecular events that are associated with the additional cytogenetic abnormalities of blast phase will most likely reveal alterations of other important growth regulatory genes which contribute to the multistep nature of malignant transformation in CML.