Roles of extracellular vesicles in the pathogenesis of chronic myeloid leukemia

Extracellular vesicles (EVs) are lipid bilayer-enclosed particles released by cells into the extracellular space. They are produced by the majority of cell types under both physiological and pathological conditions. EVs mediate intercellular communication by delivering bioactive molecules - such as RNAs, adhesion molecules, signaling mediators, and antigen-presenting molecules - to recipient cells, thereby modulating their phenotype and function. A growing body of evidence highlights the involvement of EVs in the pathophysiology of leukemia, including their roles in remodeling the bone marrow microenvironment, promoting angiogenesis, enabling immune evasion, regulating apoptosis, and contributing to drug resistance. Beyond their functional roles, EVs are emerging as promising diagnostic and prognostic biomarkers, as well as potential drug delivery vehicles. This review first outlines key aspects of chronic myeloid leukemia and the bone marrow niche, and then focuses on the current understanding of how EVs contribute to the transformation of a normal bone marrow environment into a leukemic one. Finally, we discuss the potential applications of EVs as biomarkers and therapeutic delivery systems in chronic myeloid leukemia. Extracellular vesicles (EVs) participate in intercellular communication. CML cell derived EVs contribute to the remodeling of bone marrow microenvironment. EVs participate in spreading of imatinib resistance among cells. EVs carry diagnostic/prognostic markers and can be used as drug delivery vehicles.