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Chronic Myeloid Leukemia (CML) is a biphasic malignant clonal disorder thatprogresses, first with a chronic phase, where the cells have enhancedproliferation only, and then to a blast phase, where the cells have the abilityof self-renewal. It is well-recognized that the Philadelphia chromosome (whichcontains the BCR-ABL fusion gene) is the "hallmark of CML". However, empiricalstudies have shown that the mere presence of BCR-ABL may not be a sufficientcondition for the development of CML, and further modifications related totumor suppressors may be necessary. Accordingly, we develop a three-mutationstochastic model of CML progression, with the three stages corresponding to thenon-malignant cells with BCR-ABL presence, the malignant cells in the chronicphase and the malignant cells in the blast phase. We demonstrate that the modelpredictions agree with age incidence data from the United States. Finally, wedevelop a framework for the retrospective estimation of the time of onset ofmalignancy, from the time of detection of the cancer.

Studying the age of onset and detection of Chronic Myeloid Leukemia using a three-stage stochastic model