Mathematical models of chronic myeloid leukemia (CML) cell population dynamics are being developed to improve CML understanding and treatment. We review such models in light of relevant findings from radiobiology, emphasizing 3 points. First, the CML models almost all assert that the latency time, from CML initiation to diagnosis, is at most ϳ 10 years. Meanwhile, current radiobiologic estimates, based on Japanese atomic bomb survivor data, indicate a substantially higher maximum, suggesting longer-term relapses and extra resistance mutations. Second, different CML models assume different numbers, between 400 and 10 6 , of normal HSCs. Radiobiologic estimates favor values > 10 6 for the number of normal cells (often assumed to be the HSCs) that are at risk for a CML-initiating BCR-ABL translocation. Moreover, there is some evidence for an HSC dead-band hypothesis, consistent with HSC numbers being very different across different healthy adults. Third, radiobiologists have found that sporadic (background, agedriven) chromosome translocation incidence increases with age during adulthood. BCR-ABL translocation incidence increasing with age would provide a hitherto underanalyzed contribution to observed background adult-onset CML incidence acceleration with age, and would cast some doubt on stage-number inferences from multistage carcinogenesis models in general. (Blood. 2012; 119(19):4363-4371)
IntroductionChronic myeloid leukemia (CML) is characterized by Ph ϩ cells, that is, cells having a Philadelphia (BCR-ABL) chromosome translocation. 1,2 Treatment with the tyrosine kinase inhibitor (TKI) imatinib mesylate ("imatinib"), which suppresses bcr-abl oncoprotein action, 3 improves patient prognosis dramatically. 4 However, in some cases this treatment fails, a problem mitigated but not fully solved by the use of more recently developed TKI. 5,6 Moreover, many patients may need to continue TKI treatment indefinitely to avoid relapse. 7 CML is one of the best understood cancers; it has a simpler etiology than most cancers 8 and its time course is comparatively easy to monitor in the clinic. 9,10 Consequently, despite being much less prevalent than major solid tumors, CML has often been regarded as a kind of "model organism" for quantitative modeling of human carcinogenesis. 11,12
CML cell population dynamicsIn this review, we emphasize how radiobiologic studies impact CML models grounded in understanding underlying cell population dynamics. These models track CML time evolution by differential equations and/or stochastic formalisms. Such biologically based quantitative models are more ambitious, more comprehensive, and as yet less definitive than models often used in statistical analyses, which emphasize correlations analyzed by adjusting parameters in functions chosen mainly for mathematical convenience.After work by Rubinow and Lebowitz 13 on hematopoiesis, biologically based, mathematical CML models were pioneered by Clarkson and coworkers. 14 Many additional models have been suggested in the last decade. Recent a...