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Tyrosine Kinase Inhibitors (TKI’s) offer highly selective therapy for Chronic Myeloid Leukaemia (CML). In particular, imatinib (Gleevec™/ Glivec® from Novartis) can limit or eliminate disease progression and many patients show sustained remission. However, a minority of patients either fail or respond sub-optimally and it is now well documented that this loss of efficacy is associated with the appearance of resistance mutations that cluster in the kinase domain of the BCR-ABL fusion protein. A critical mutation is T315I which also shows resistance to other TKIs (such as dasatinib (Sprycel™)). The mutations arise on a low background of residual BCR-ABL fusion transcript in circulating blood cells. Sensitive and selective detection of emerging resistant clones may be important in the management of CML. In order to detect these low level emergent alleles, we have combined sensitive and selective ARMS® (allele specific PCR) with Scorpions® real-time PCR technology.
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