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Background: Dasatinib (DAS) has shown superiority over imatinib in achieving cytogenetic and molecular responses in chronic phase (CP) CML but with a different toxicity profile, which may impact on its overall benefit. Reported tox- icities from the DASISION trial at 5 years include pleural effusions (PE) (29%), pulmonary hypertension (PHTN) (5%), and low rates of arterial ischemic events. While the literature well describes the incidence of these events, the response to therapy and the impact of subsequent dose modifications on the outcome of the toxicity have generally not been comprehensively characterised. Aim(s): To review the incidence of these side-effects in a snapshot survey of Australian patients (pts) receiving DAS, either as first or subsequent line of therapy for CML-CP, with a focus on risk factors and the response of the toxicity to therapeutic changes. Method(s): Retrospective study of all eligible pts (received DAS for CML-CP and access to sufficient data) at 17 Australian institutions. Each pt's history was tracked in detail to identify any complications potentially attributable to DAS, and the treatment and outcome of these complications in response to cessation or alterations in DAS dose or schedule. Result(s): 221 pts were evaluable, with a median age at DAS commencement of 53 years (range 20 - 86) and median starting dose of 100mg (20-140). 51 (23%) received DAS as 1st line therapy, 133 (60%) 2nd line and 37 (17%) 3rd line. The median follow up from DAS commencement was 27 months (4 -116 months). No side effects were reported in 105 (48%) pts. Of the 116 (52%) pts with side-effects, the most common side effect was PE, observed in 53 (24%) pts with a median age of 65 years (41-86 years) and with median time to onset of 11 months (0.5-59 months). Most (40 pts, 76%) were receiving DAS as 2nd line therapy. DAS dose at PE onset was 100mg in 37 pts (70%), 140mg in 9 pts (17% PEs; notably 38% of pts on this dose developed PE), 70mg in 4 pts, 80mg in 2

Background: Dasatinib (DAS) has shown superiority over imatinib in achieving cytogenetic and molecular responses in chronic phase (CP) CML but with a different toxicity profile, which may impact on its overall benefit. Reported tox- icities from the DASISION trial at 5 years include pleural effusions (PE) (29%), pulmonary hypertension (PHTN) (5%), and low rates of arterial ischemic events. While the literature well describes the incidence of these events, the response to therapy and the impact of subsequent dose modifications on the outcome of the toxicity have generally not been comprehensively characterised. Aim(s): To review the incidence of these side-effects in a snapshot survey of Australian patients (pts) receiving DAS, either as first or subsequent line of therapy for CML-CP, with a focus on risk factors and the response of the toxicity to therapeutic changes. Method(s): Retrospective study of all eligible pts (received DAS for CML-CP and access to sufficient data) at 17 Australian institutions. Each pt's history was tracked in detail to identify any complications potentially attributable to DAS, and the treatment and outcome of these complications in response to cessation or alterations in DAS dose or schedule. Result(s): 221 pts were evaluable, with a median age at DAS commencement of 53 years (range 20 - 86) and median starting dose of 100mg (20-140). 51 (23%) received DAS as 1st line therapy, 133 (60%) 2nd line and 37 (17%) 3rd line. The median follow up from DAS commencement was 27 months (4 -116 months). No side effects were reported in 105 (48%) pts. Of the 116 (52%) pts with side-effects, the most common side effect was PE, observed in 53 (24%) pts with a median age of 65 years (41-86 years) and with median time to onset of 11 months (0.5-59 months). Most (40 pts, 76%) were receiving DAS as 2nd line therapy. DAS dose at PE onset was 100mg in 37 pts (70%), 140mg in 9 pts (17% PEs; notably 38% of pts on this dose developed PE), 70mg in 4 pts, 80mg in 2

Small Businesses account for a significant portion of the Australian business sector. With Business Process Management (BPM) gaining prominence in recent decades as a means of improving business performance, it would seem to only be a matter of time before it gains momentum within the Small Business sector. One may even question why it has not already achieved more traction within the sector. This case study involves a BPM initiative to develop process infrastructure in an establishing Small Business. It explores whether mainstream BPM tools, techniques and technologies can be applied in a Small Business setting. The chapter provides a background to the case organisation, outlines the activities undertaken in the BPM initiative and distils key observations drawn from participation in the initiative and consultation with stakeholders. Based on the case study experiences, a number of implications are identified for further consideration by the BPM discipline as it continues to address the question of how it can become more widely adopted amongst Small Businesses.