Evolutionary tales in leukaemia

Mel Greaves1

1The Institute of Cancer Research, Sutton, UK

Abstract

Distilling complexity down to underlying principles and coherent explanations is the challenge, and attraction, of all science.  Understanding causation of disease is problematic in this respect as we tend to focus our attention on what are, in reality, individual components of a multi-factorial network of causative mechanisms. I have spent most of my scientific career on a journey trying to understand why and how children develop leukaemia.  In so far as this research has been guided by an underlying philosophy, it has been that the answer to the question posed will reside in the basic biology of the disease and be informed by the ‘natural experiments' provided by patients themselves.  And that an evolutionary biology perspective should help provide coherence of explanation.  In retrospect, I see this choice of direction and mode of travel as being forged by a few key influences, both academic and personal, early on in my career. The current picture I will outline was initiated ~30 years ago with minimal clues spawning a speculative hypothesis but then constructed, piecemeal, with cellular, genetic and epidemiological studies, all of them collaborative.  The outcome, or proferred explanation of causality, posits childhood acute lymphoblastic leukaemia as an evolutionary dilemma and a paradox of progress.  And a potentially preventable cancer.