Chronic myeloid leukemia (CML) is a clonal stem-cell disorderin which the reciprocal translocation t(9;22) generates twonovel fusion genes: BCR-ABL on the derivative 22q (Philadelphia)chromosome, and ABL-BCR on chromosome 9q+. The ABL gene productis a protein tyrosine kinase, and the fusion protein BCR-ABLhas constitutive kinase activity that deregulates signal transductionpathways, causing abnormal cell cycling, inhibition of apoptosis,and increased proliferation of cells. The natural course ofthe disease is usually characterized by three sequential phases(the chronic, accelerated, and blast-crisis phases), duringwhich there is progressively more resistance to therapy.
From the Royal Free and University College London Medical School, London.
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