A schematic representation of the role of progressive telomere shortening in driving CLL progression based on current knowledge, with a main focus on the results from Lin et al in this issue.1 CLL proliferation is induced by either genetic or environmental stimuli. Repeated courses of cell division as well as other telomeric stressors induce progressive telomere shortening. Due to the inactivation of the senescence checkpoint, cells with critically shortened telomeres enter a crisis-like condition that leads to genomic instability allowing further clonal evolution and disease progression. Professional illustration by Kenneth X. Probst.
