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1.  BCR-ABL1 kinase domain mutations may persist at very low levels for many years and lead to subsequent TKI resistance 
British Journal of Cancer  2013;109(6):1593-1598.
BCR-ABL1 mutation analysis is recommended for chronic myeloid leukaemia patients. However, mutations may become undetectable after changing therapy, and it is unknown whether they have been eradicated.
We examined longitudinal data of patients with imatinib-resistant mutations, which became undetectable by Sanger sequencing to determine whether mutations could reappear, and the related circumstances.
Identical imatinib- and nilotinib-resistant mutations reappeared following further therapy changes in five patients, and was associated with subsequent nilotinib resistance in four.
The data suggest that some BCR-ABL1 mutations may persist at undetectable levels for many years after changing therapy, and can be reselected and confer resistance to subsequent inhibitors.
PMCID: PMC3776970  PMID: 23799845
chronic myeloid leukaemia; mutation analysis; tyrosine kinase inhibitor; resistance
2.  Screening for breast cancer. 
BMJ : British Medical Journal  1994;308(6931):792.
PMCID: PMC2539625  PMID: 8142849
3.  Radiographic examination of the lumbar spine in a community hospital: an audit of current practice. 
BMJ : British Medical Journal  1991;303(6806):813-815.
OBJECTIVE--To assess general practitioners' decisions to request lumbar spine radiographs according to the guidelines of the Royal College of Radiologists. DESIGN--Prospective questionnaire survey of outpatients attending for lumbar spine radiography. SETTING--London community hospital. SUBJECTS--100 consecutive adult outpatients attending for lumbar spine radiography at their general practitioner's request. MAIN OUTCOME MEASURES--Patient's history and clinical signs; radiological diagnosis; change in management of patients with significant radiological abnormality in response to the radiologist's report. RESULTS--60 patients were aged between 18 and 45, 27 (45%) of whom were women. Five patients were fully examined by their doctor before radiographs were requested, 76 were partially examined, and 19 were not examined. In 37 patients the examinations showed radiologically normal findings; 30 had radiologically significant disc or degenerative disease. Pain score and radiological diagnosis was not correlated (6.43 (range 1-10) for patients with significant disease v 6.14 (range 1-10) for those without, p greater than 0.05). There were no cases of malignancy or infection. One patient with radiologically significant disease was referred to a hospital specialist, and the management of only two such patients was altered by the report. 52 of the examinations should not have been requested if the guidelines had been strictly applied. CONCLUSIONS--There is a need to inform doctors of the efficacy of radiological examinations. An awareness of the college's guidelines among general practitioners should be actively promoted by radiologists.
PMCID: PMC1671162  PMID: 1932970

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