2.1. Chronic myeloid leukemia

A genetic rearrangement (translocation) involving the BCR gene causes a type of cancer of blood-forming cells called chronic myeloid leukemia. This slow-growing cancer leads to an overproduction of abnormal white blood cells. Common features of the condition include excessive tiredness (fatigue), fever, weight loss, and an enlarged spleen.

The translocation involved in this condition, written as t(9;22), fuses part of the ABL1 gene from chromosome 9 with part of the BCR gene from chromosome 22, creating an abnormal fusion gene called BCR-ABL1. The abnormal chromosome 22, containing a piece of chromosome 9 and the BCR-ABL1 fusion gene, is commonly called the Philadelphia chromosome. The translocation is acquired during a person's lifetime and is present only in the abnormal blood cells. This type of genetic change, called a somatic mutation, is not inherited.

The protein produced from the abnormal fusion gene, called BCR-ABL1, signals for cells to grow and divide and blocks the self-destruction of cells that are abnormal or unneeded. The BCR-ABL1 protein is always turned on, so growth and division of affected blood cells is uncontrolled, leading to overproduction of the abnormal cells.

The presence of the Philadelphia chromosome provides a target for molecular therapies.

2.2. Other cancers

The BCR-ABL1 fusion gene (described above) is also involved in fast-growing blood cell cancers called acute leukemias. It has been found in 5 percent of children and up to 30 percent of adults with B-cell acute lymphoblastic leukemia and very rarely in acute myeloid leukemia. As in chronic myeloid leukemia, the BCR-ABL1 protein stimulates overproduction of abnormal white blood cells, leading to cancer. It is likely that the form of blood cancer that develops is influenced by the type of blood cell that acquires the mutation and other genetic changes that occur.