Two conditions are required for the development of leukemia: susceptibility of the organism (e.g., chromosomal mutation or relatively weak, immune deficiency) and environmental factors (viral, chemical, radiological, etc.).
The susceptibility of the organism involves genetic mutations and genetic alterations, on top of which the “second strike” by adverse factors, i.e., various causes of decisive mutations in individual cells, activation of certain signaling pathways, leads to clonally abnormal hematopoietic cell production and strong proliferation, blocked apoptosis, and further genetic alterations. This leads to blocked or disturbed differentiation of blood cells, and the number of leukemic cells in the body reaches about 10 to be recognized as leukemia in the available tests, so there is usually an accumulation history of more than 2 years.
Some patients first present with myelodysplastic syndrome, commonly referred to as “pre-leukemia,” and then progress to classic leukemia over a number of years. The first step in the process is the development of a new leukemia, but it is debatable whether this accumulation process is called the “latent phase”, because it is possible not to progress to leukemia by adjusting the body’s immunity and removing exposure to adverse factors.
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