Substitution of 13 amino acids were found to be present in kinase domain of BCR-ABL in Gleevec resistant tumour.
There are quite a lot of mutations that show up on the Kinase domain upon Gleevec treatment. Most of the them are simple substitutions of 1 amino acid. The 13 aa substitution is from 1 report.
Patient non-compliance with imatinib treatment and/or enrichment in a pre-existing resistant clone.
On a mechanistic side, see more about ERK1/2 involvement
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