Abstract

Tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukaemia (CML) is the consummate success story for targeted therapy, yet relapse is a nearly inevitable consequence of cessation or interruption of therapy. Primitive TKI-refractory CML stem cells are the likely source of these relapses, as they provide sanctuary for the Philadelphia chromosome. In advanced disease, their progressively anaplastic progeny ultimately maintain CML independently of the CML haematopoietic stem cell (HSC). Interestingly, there are at least two distinct cell types capable of self-renewal in different phases of CML: first, a primitive HSC with BCR–ABL mutation, which maintains the more indolent chronic-phase disease and, second, a coexisting mutated progenitor cell which acquires stem cell characteristics responsible for rapid cell expansion in advanced disease.

Author affiliations

1. University of Michigan, Internal Medicine–Hematology Oncology, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109–45936, USA.

Correspondence to: Moshe Talpaz¹ Email: mtalpaz@med.umich.edu

Correspondence to: Michael Savona¹ Email: msavona@med.umich.edu

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