Leukemias are monoclonal diseases that arise from cells in the hematopoietic stem and progenitor cell compartment. Consistent with emerging models of carcinogenesis, leukemogenesis is an evolutionary process that involves multiple independent genetic and epigenetic events. Over the last half-century a predominant paradigm has emerged to describe leukemia developing secondary to alkylating drug therapy or exposure to benzene in which progressive dysplastic changes, accompanied by a distinct pattern of clonal cytogenetic abnormalities, give rise to acute myelogenous leukemia. Characterization of these clonal chromosomal aberrations, together with observed alterations in other growth-promoting genes, provides a useful framework for studying chemical leukemogenesis and for use in understanding the origins and development of leukemia in general.