Oncofusion

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Analysisstrong confidence 4 of 5: Replicated in peer-reviewed work by more than one group.Q40-counter-evidence-quality

Reading the same-source counter-evidence: 77 notes adjudicated, and the defect is not the one the metric measures

also called Q40 counter-evidence quality sweep · same-source counter-evidence audit · is 82.9% independence real

Most of the graph's counter-arguments cite a different paper from the claim they oppose, which looks like a sign of health; about a sixth cite the same paper. We read 77 of those same-paper notes closely and found that almost all are legitimate, but that the few bad ones fail in a way nobody was checking for: the note states a fact from some other paper while wearing the cited paper's identifier.

The same thing, for a scientist

A disk census found 6,412 counter-evidence notes in the graph, of which 5,317 (82.9%) cite a source different from the claim they oppose and 1,092 cite the same source, 646 of those with a PMID or DOI. This sweep is the first to READ rather than count them: 77 notes across 42 entries, prioritised by stake (intervention-touching entries, `established`/`strong` grades, and entries whose ids are heavily referenced elsewhere). The three-way split was 38 legitimate author's-own-caveat/own-data notes, 33 legitimate-by-necessity scope or bounded-absence arguments, and **6 genuine gaps where independent literature existed and was not cited (7.8%)**. All six were repaired in place with independently fetched citations; none of the original notes was deleted. The headline finding is that same-source opposition in this graph is overwhelmingly sound, so 82.9% is not propped up - but that the metric is measuring the wrong thing. It counts whether a counter-note's citation DIFFERS from the claim's; it cannot see whether the citation SUPPORTS the note. In every one of the six gaps the note asserted an external fact under the claim's own PMID, which scores as same-source (conservative, honest-looking) while being a mis-citation. `verify-citations.py` passes these by construction because the PMID and title agree with each other, and `verify-claims.py` scores the evidence `claim` and never looks at `counter_evidence[].note`. A second, purely mechanical defect was measured at the same time: **39 same-PMID counter-note citation blocks carry a TRUNCATED title** copied from a listing rather than a fetched record.

Go deeper
The answer to the question the beat was sent to settle

Is 82.9% independence a real number, or is it propped up by counter-notes that gesture at independence without carrying it?

After 77 careful reads the honest answer is: the number is real, and it is also the wrong number.

Real, because the same-source notes are in good shape. 71 of 77 were legitimate and several were excellent - a paper's own in vivo failure set against its own in vitro headline (target-mcl1-with-bcl2-and-dexamethasone-infant-kmt2a-all E1), a study's own agreement analysis set against the discordant tail the entry was built on (risk-mrd-target-choice-changes-who-is-intensified E1), a diagnostic paper's own three false positives and eight false negatives (concept-flow-cytometry-immunophenotype-kmt2a-r E3). The brief's instinct that same-source opposition is often the strongest opposition available is confirmed by the sample, and nothing in this sweep was deleted.

Wrong, because same-source and independent are not the two categories that matter. The 6 defective notes were all same-source by accident: they stated a fact drawn from some other paper and inherited the claim's citation block because nobody attached a new one. Had the writer attached any second identifier, the same defective note would have counted toward the 82.9%. The metric rewards the motion that produces the error.

So the recommendation is not 'reduce same-source notes'. It is: measure whether a counter-note's citation supports its own text, which nothing in this repo currently does.

The three-way split, with the counts
categorynotesshare
1. The paper's own caveat or its own data3849.4%
2. Legitimate by necessity - scope argument or bounded absence3342.9%
3. A gap: independent literature existed and was not cited67.8%
total adjudicated77across 42 entries

Two things about the boundary between 1 and 2, because the brief's definition of category 1 is narrower than what the graph actually contains.

Most category-1 notes are not the authors' stated limitation. They are the reviewing agent's reading of the paper's own data against the entry's interpretation. That is a stronger form of same-source opposition than a quoted limitations paragraph, not a weaker one, but it is a different thing and the notes rarely say which they are. Where a note IS the authors' own statement - cell-state-pro-b-arrest E_jansen, risk-mrd-target-choice-changes-who-is-intensified E2 - it is worth one word to say so, because a reader weighs 'the authors concede' differently from 'the reviewer infers'.

The category-2 population is dominated by one shape, repeated across seven fusion entries: the KMT2A recombinome (PMID 37019990) is a referral series, so every percentage taken from it is a share of referrals rather than of the disease. That argument cannot be made with a second paper, because no population-based partner-distribution comparator is published; it is legitimate by necessity and it is correctly stated. The sweep checked Interfant-06 (PMID 31283407) as a prospective comparator and the published abstract does not give a partner breakdown, so nothing was added.

The six gaps, and what was added to each

Each repair adds a note alongside the original; nothing was removed, and every identifier below was fetched from PubMed or the primary source in this session rather than copied from a sibling entry.

1. drug-silmitasertib E2 - the worst of the six, and it was in a caveat rather than a note. The entry argued for hitting CKII instead of taspase1 because a 30-million-compound virtual screen against taspase1 failed, and its caveat said this was 'the only substantive public information on taspase1's druggability'. That is false. PMID 22166309 (Chen et al., Cancer Res 2012) reports NSC48300, a reversible non-competitive taspase1 inhibitor at Ki = 4.22 uM that inhibited tumour growth in MMTV-neu and U251 models, and notes that Taspase1-null mice have no overt deficit. PMID 38958349 (Hommel et al., Chem Eur J 2024) reports multivalent molecular tweezers against taspase1's surface loop at nanomolar affinity with efficient proteolytic inhibition. Neither was cited anywhere in this graph. The caveat was corrected and both papers added as counter-evidence with their limits stated (micromolar arsonic acid, no leukaemia model; supramolecular chemistry, no cellular cleavage assay).

2. mechanism-kmt2a-subnuclear-localization E5 - the graph cited the right paper in ten other entries. The note argued, correctly, that 'SEC associates with every chimera tested' does not generalise across partner classes, and supported it with 'a 15-residue gephyrin tubulin-binding domain from a protein with no transcriptional activity is sufficient to transform' - under PMID 20159561, the SEC purification paper, which does not contain that result. It is PMID 14751928 (Eguchi, Eguchi-Ishimae & Greaves, Blood 2004), The small oligomerization domain of gephyrin converts MLL to an oncogene, and this graph already cites it in ten entries. This is the mirror of the gene-ssrp1 failure Rule 64 was written for: there, an absence was declared while the disproving paper was cited four times elsewhere; here a finding was asserted while its source was cited ten times elsewhere.

3. cell-type-fetal-liver-hsc E1 - and the independent literature turns out to disagree with itself. The note asserted 'LIN28B is required for KMT2A::AFF1 to transform human fetal liver CD34+ cells at all' under PMID 30679323, which contains no LIN28B experiment. The source is PMID 42213620 (Ling et al., Blood), cited once elsewhere in the graph but not here. Fetching it surfaced something the same-source note could never have shown: PMID 36763502 (Eldeeb et al., Cell Rep 2023) reports that in an MLL-ENL/LIN28B dual-transgenic mouse LIN28B impedes MLL-rearranged AML through suppressed MYB signalling and proposes fetal LIN28B as protection against MYB-dependent AML. That paper was cited nowhere in this graph. Required in human fetal B-lymphoid transformation, protective in mouse myeloid disease - both were added, with the lineage/species caveat that the disagreement may not be a contradiction.

4. risk-menin-pocket-occupancy-endocrine-late-effects E1 - a counter-note that went stale when its own entry was corrected. The note ended 'Nothing published shows it does.' The entry itself carries a CORRECTION section and an E3 recording that the REVUFORJ label reports intact PTH increased in 34% of 241 patients and lists hyperparathyroidism under Endocrine disorders. The correction reached the summary, the body and the evidence array, and never reached counter_evidence. The label was re-fetched from DailyMed on 2026-09-20 (34%, N=241, denominators 139-240; phosphate increased 51% / decreased 25%; corrected calcium increased 15%, 0% grade 3-4; hyperparathyroidism under Endocrine disorders, <20%) and added as a second note, deliberately not by copying the sibling entry's identifier block.

5. target-osteoclast-inhibition-zoledronic-acid-high-risk-b-all E1 - the same-source note was true and understated the confound. Full text of PMC11868389 confirms the paper itself states dasatinib inhibits osteoclast formation and activity, and reports zoledronic acid as more potent - but attributes the dasatinib effect to two prior papers that were not cited. The primary one, PMID 20225261 (Vandyke et al., JBMR 2010), shows dasatinib alone raising trabecular bone volume and thickness in rats at levels comparable with the zoledronic-acid arm, with reduced osteoclast number, surface and serum CTX-1. Cited independently, the confound in the BCR::ABL1 combination arms is larger than the index paper's supplementary comparison implies.

6. cell-state-under-menin-inhibition E3 - an uncited 'well documented'. The note argued that the revumenib lineage-switch observation may be a general dose-of-oncoprotein effect, on the basis that 'lineage switch in KMT2A-rearranged leukaemia is well documented after CD19-directed therapy' - with no citation. PMID 26914337 (Rayes, McMasters & O'Brien, Pediatr Blood Cancer 2016) reports an infant with t(4;11) ALL who switched to CD19-negative monoblastic AML on blinatumomab: index fusion, index age, and a drug that does not touch menin. It was cited nowhere in the graph. The bounding query is recorded in the new note.

What I did not expect: the failure mode is a mis-citation that every checker passes

Going in, the expected failure mode was the one the brief describes - a lazy same-source note where a second study existed and nobody looked. That is not what the sample contains. In five of the six gaps the writer HAD read independent literature; the fact in the note is correct and the reasoning is good. What is missing is the identifier. The note inherited the claim's citation block because the counter-evidence array has no convention for 'this note's source differs from its parent's'.

This produces a defect with a specific and nasty signature:

  • verify-citations.py passes it by construction. The stored PMID and the stored title agree with each other and with PubMed. The script's whole design is to catch a title that describes a different paper; here the title describes exactly the right paper, cited for something it does not say.
  • verify-claims.py cannot see it. It scores each evidence item's claim against its abstract. counter_evidence[].note is not in its scope at all.
  • find-contradictions.py cannot see it. The note is not contradicting a sibling entry; it is quietly unsupported.
  • And the independence metric scores it as a virtue-adjacent conservatism. A same-source note reads as cautious. This one is a citation error wearing caution's clothes.

The cheap detector, if a future cycle wants one: for every counter_evidence[] whose PMID equals its parent evidence item's PMID, score the note text against that PMID's abstract the way verify-claims.py scores a claim, and rank the worst. All six gaps here would rank badly, because each note's decisive sentence is about a molecule or a result the abstract never mentions. That is the same instrument this project already has, pointed at a field it was never pointed at.

A second thing I did not expect: 39 truncated titles. A mechanical scan of every same-PMID counter-note found 39 whose stored title is a strict PREFIX of the correct title - the listing-truncation trap the brief documents, sitting inside counter-evidence citation blocks where no checker looks. verify-citations.py passes them because an idf-weighted overlap on the first 80-130 characters is high. Two were fixed in cell-type-fetal-liver-hsc during this sweep, from a title fetched in-session; the remaining 39 are listed below for the coordinator, because fixing them from the sibling evidence item's title would be exactly the second-hand-identifier motion the brief forbids.

Queries run for the category-2 absences

Recorded so the decisions are re-runnable, per the standing bounded-rejection rule.

purposequery / routeresult
Is taspase1 genuinely undruggable?PubMed taspase1 inhibitor small molecule5 records, of which PMID 22166309 and 38958349 are direct inhibitor papers; 0 of 5 were cited in this graph
Primary source for the dasatinib/osteoclast confoundPubMed dasatinib dysregulates bone remodeling inhibition of osteoclasts in vivo Vandyke1 record, PMID 20225261, not in this graph
Is the gephyrin result elsewhere?PubMed gephyrin oligomerization domain MLL oncogene2 records; PMID 14751928 is the source, and grep of this repo shows it already cited in 10 entries
LIN28B and KMT2APubMed LIN28B AND (MLL OR KMT2A) AND leukemia7 records; 42213620 cited once in this graph, 36763502 cited nowhere
Lineage switch without menin inhibitionPubMed "lineage switch"[tiab] AND (KMT2A[tiab] OR MLL[tiab]) AND (leukemia[tiab] OR leukaemia[tiab])58 records; the literature is real and was not being cited at this note
Is the WRAD-versus-fusion absence real?not re-run - ana-wrad-fusion-evidence-enumeration records 24 PubMed and 7 Europe PMC queries including the complex form (COMPASS AND (MLL-AF4 OR ...), bare (WRAD OR ...)), so Rule 64 is satisfiedabsence stands; the 4 notes were annotated to say so rather than repaired
Population comparator for recombinome sharesInterfant-06 PMID 31283407 abstract re-fetchedno partner-distribution breakdown published in the abstract; no comparator added, the scope note stands as category 2
REVUFORJ endocrine signalDailyMed setid 6eb3cdbc-0e74-477d-82d6-3bb172d3f63f, fetched 2026-09-20intact PTH increased 34% (N=241, denominators 139-240); hyperparathyroidism listed under Endocrine disorders at <20%
The 39 truncated-title counter-note citations, for the coordinator

Every row is a counter_evidence[].citation.title that is a strict prefix of the same block's correct title (taken as the parent evidence item's title, which verify-citations.py validates against PubMed). Each needs the title re-fetched, not copied.

breakpoint-kmt2a-spliced-fusion-partner-exon-2 E3 (37019990) - concept-bruising-petechiae-thrombocytopenia E2 (34054042) - concept-endocrine-endpoint-absence-menin-trial-registries E4 (39121437) - concept-flow-cytometry-immunophenotype-kmt2a-r E3 (12886247, 82 of 180 chars) - concept-men1-loss-to-endocrine-tumour-latency E3 (17590169), E6 (25594862) - concept-phase2-go-no-go-register E7 (9474863) - cost-frontline-infant-leukemia-care E2 (32589365) - disease-infant-all E1 (31283407) - endocrine-men1-pancreatic-neuroendocrine-tumour E1 (17590169), E2 (25594862) - endocrine-men1-pituitary-adenoma E2 (25594862) - endocrine-men1-primary-hyperparathyroidism E2 (25594862), E4 (9683585) - epi-men1-age-penetrance-curve E2 (9683585) - gene-rnf20 E3 (28690313), E5 (41533567) - gene-ube2a E5 (32415735) - gene-wac E3 (41533567), E5 (26757981) - hyp-h2bub-direction-is-unknown-in-kmt2a E2 (28690313) - hyp-menin-inhibition-perturbs-parathyroid-axis-dose-dependently E3 (17590169) - mechanism-condensates-load-bearing-or-correlative E7 (35073946) - mechanism-fusion-dna-targeting-cxxc-athooks E4 (28076791) - mechanism-hoxa9-meis1-output-program E5 (32242051), E7 (34088716) - platform-trk-inhibitor-tumour-agnostic-precedent E2 (29606586), E3 (31838007) - pt-story-infant-all-kmt2a-aff1-hyperleukocytosis E1 (39717192, reversed - the EVIDENCE title is the short one here) - reg-breakthrough-and-accelerated-approval E11 (40136298) - resistance-cross-resistance-between-menin-inhibitors E3 (41351513) - resistance-enl-marked-epigenetic-memory E3 (40536420) - resistance-men1-interface-mutations E2 (41351513) - resistance-tp53-apoptotic-priming-menin E3 (41351513) - risk-menin-inhibitor-exposure-duration-vs-men1-latency E5 (36552783, 54 of 221 chars) - risk-revumenib-intact-pth-elevation E2 (39121437), E3 (17590169) - subtraction-kmt2a-tad-cbp-contact E4 (30573454) - subtraction-kmt2a-taspase1-cleavage-sites E8 (30573454).

Also found while scanning: 3 counter_evidence items are bare strings rather than objects, and 15 are objects with no citation at all. Those 18 are invisible to every identifier check in the repo and are not counted anywhere in the 6,412/5,317/1,092 census.

What should change in how this graph records counter-evidence

Four concrete things, in order of how much they would have caught here.

  1. A counter-note that cites its parent's source must say why. One of three words at the front: the authors' own caveat, the paper's own data, or scope. The sweep added that framing where it repaired a note. It costs a phrase and it tells a reader whether the opposition is conceded by the paper or inferred by us.
  2. A counter-note that states a fact from elsewhere must carry its own identifier. All six gaps are this rule being broken. The array already supports a per-note citation; nothing enforces that the note's content matches it.
  3. Score counter_evidence[].note against its own PMID's abstract, as a small extension of verify-claims.py. This is the only mechanical check that would have found any of the six.
  4. When an entry is corrected, sweep its counter_evidence array. risk-menin-pocket-occupancy-endocrine-late-effects is the worked example: an entry that carries a prominent CORRECTION section refuting 'nobody has looked', with a counter-note three fields away still ending 'Nothing published shows it does.' The existing rule do not leave an entry arguing with itself was written for the body contradicting the counter-evidence; this is the same defect in the other direction and the rule should say so.
Facts and figures
scriptread by hand; mechanical scans in scratchpad q40_extract.py / q40_stake.py / q40_titles.py
statusrun
result summary77 same-source counter-notes adjudicated across 42 entries: 38 category 1 (the paper's own caveat or its own data), 33 category 2 (legitimate by necessity - scope argument or bounded absence), 6 category 3 (a gap; independent literature existed and was not cited). All 6 repaired in place with independently fetched citations; 0 original notes deleted. 6 new independent papers added to the graph, 4 of which (PMID 22166309, 38958349, 36763502, 26914337) were cited nowhere in the graph before this sweep. Separately, 39 same-PMID counter-note citation blocks carry a truncated title and 18 counter_evidence items carry no citation at all.
sample fraction77 of 646 (11.9%), prioritised by stake rather than sampled at random - so the 7.8% gap rate is an estimate over the highest-stake tail, not over the queue
gap rate in sample0.078
inputs
[
  "data/graph/nodes/*/*.json (1,352 entries indexed, acetylation-cycle excluded)",
  "coordinator census: 6,412 counter-evidence notes, 5,317 (82.9%) different-source, 1,092 same-source, 646 with a paper identifier"
]
repaired entries
[
  "drug-silmitasertib",
  "mechanism-kmt2a-subnuclear-localization",
  "cell-type-fetal-liver-hsc",
  "risk-menin-pocket-occupancy-endocrine-late-effects",
  "target-osteoclast-inhibition-zoledronic-acid-high-risk-b-all",
  "cell-state-under-menin-inhibition"
]
annotated entries
[
  "gene-wdr5",
  "gene-ash2l",
  "gene-dpy30",
  "gene-rbbp5"
]
new independent pmids
[
  "22166309",
  "38958349",
  "14751928",
  "42213620",
  "36763502",
  "20225261",
  "26914337"
]
How this could bite us back
  • Repairing counter-evidence makes entries look better audited than they are. Six notes now carry fresh independent citations in a graph where 569 same-source notes remain unread, and a reader cannot tell the read from the unread. The 39-title queue and this entry's open questions are the only marker.
  • Adding PMID 22166309 to drug-silmitasertib weakens the argument for an existing entry's whole premise without replacing it. If taspase1 is addressable after all, the case for attacking CKII as the tractable node is softer than the entry states, and nobody has re-derived the strategy - the sweep corrected a factual claim and left a strategic conclusion resting on it.
  • The LIN28B repair introduces a contradiction the graph now has to hold: required in one model, protective in another. An entry that cites both is more honest and less usable, and a future beat that wants a clean statement about fetal context will be tempted to drop one of them.
Still open
  1. What is the gap rate over the REST of the 646? This sample was taken from the high-stake tail, where entries have been read most often and are most likely to be sound; the untouched 569 could be better or worse and there is no way to tell from here without reading more.
  2. Would scoring counter_evidence[].note against its own PMID's abstract - the verify-claims.py instrument pointed at a field it has never been pointed at - rank all six of this sweep's gaps at the bottom? If it does, the check is cheap and general; if it does not, the defect class needs a different detector.
  3. How many counter-notes elsewhere in the graph assert an external fact under the parent's PMID? A keyword probe for 'is known to' / 'well documented' / 'another study' among same-source notes returned only 3 candidates, which is implausibly few given that 6 of 77 hand-read notes were gaps - so the linguistic signature is weak and the real rate is unmeasured.
  4. Should the recombinome referral-series scope note be consolidated? The identical argument is copy-pasted across at least seven fusion entries; a single concept entry with seven pointers would be one place to correct instead of seven, and this sweep found two separate cases where a correction reached one entry and not its siblings.
Every source behind this entry (7)
  1. E1moderate confidence 3 of 5: One strong study, or several smaller consistent ones.paper

    A pharmacologic inhibitor of taspase1 exists in the published literature: NSC48300, identified from the NCI diversity library in a cell-based dual-fluorescent proteolytic screen, is a reversible non-competitive taspase1 inhibitor with Ki = 4.22 micromolar that inhibited tumour growth in the MMTV-neu breast model and the U251 brain xenograft, and genetic deletion of Taspase1 in mouse produced no overt deficiency.

    A pharmacologic inhibitor of the protease Taspase1 effectively inhibits breast and brain tumor growth · Chen DY, Lee Y, Van Tine BA, Searleman AC, Westergard TD, Liu H, Tu HC, Takeda S, Dong Y, Piwnica-Worms DR, Oh KJ, Korsmeyer SJ, Hermone A, Gussio R, Shoemaker RH, Cheng EH, Hsieh JJ · Cancer Research 72(3):736-46 2012
    What this evidence cannot show

    Read: abstract only. Arsonic-acid chemotype at micromolar potency in breast and brain models, with no leukaemia or KMT2A-fusion experiment, and the compound was not advanced. It establishes that the site is addressable, not that taspase1 is a viable leukaemia target. It is cited here as the fact that falsifies a caveat in `drug-silmitasertib`, not as a recommendation.

    Evidence that argues against this (1)
    • The failed virtual screen this paper contradicts is real and is not nothing: 30 million compounds against the taspase1 crystal structure yielded 26 candidates and none blocked activity in vitro or in cells, and a 70% taspase1 knockdown did not affect MLL1 or MLL2 cleavage. A micromolar arsenical from 2012 that nobody advanced and a supramolecular tweezer from 2024 do not establish a conventional small-molecule route. The correction to `drug-silmitasertib` is to the word 'only', not to the strategic conclusion. Zhao Z et al. 2019
  2. E2strong confidence 4 of 5: Replicated in peer-reviewed work by more than one group.paper

    The 15-amino-acid tubulin-binding domain of gephyrin is necessary and sufficient to confer transforming activity on MLL in vitro and in vivo, despite gephyrin having no transcriptional activity, and it confers oligomerisation capacity on MLL; MLL-GPHN transduction produced both myeloid and lymphoid leukaemias in mice.

    The small oligomerization domain of gephyrin converts MLL to an oncogene · Eguchi M, Eguchi-Ishimae M, Greaves M · Blood 103(10):3876-82 2004
    What this evidence cannot show

    Read: abstract only. Cited here as the source that `mechanism-kmt2a-subnuclear-localization` E5 was using without citing, and as the demonstration that this graph already held the correct citation in ten other entries while one note carried the wrong one.

    Evidence that argues against this (1)
    • This does not make oligomerisation the universal mechanism. The graph's non-elongation-partner beat records two falsifications of 'any dimeriser will do': MLL-SEPT6 lacking its coiled coil failed to immortalise, and heterologous RA domains did not substitute for AFDN RA1. Gephyrin shows that a partner with no transcriptional activity is sufficient; it does not show that self-association is sufficient in general. Meyer C et al. 2023
  3. E3strong confidence 4 of 5: Replicated in peer-reviewed work by more than one group.paper

    LIN28B is essential for human fetal B-lymphopoiesis and for initiation of KMT2A::AFF1 infant leukaemia: in a human fetal-liver-derived CRISPR-Cas9 KMT2A::AFF1 model, fetal liver CD34+ cells fail to transform on induction of the translocation in the absence of LIN28B, and LIN28B-expressing leukaemias are more proliferative in vitro and in vivo with the advantage lost on LIN28B knockdown.

    The fetal specific gene LIN28B is essential for human fetal B-lymphopoiesis and initiation of KMT2A::AFF1 infant leukemia · Ling RE, Welsh AM, Hamer L, Jackson T, Neil E, Elliott N, Cross JW, Wuppalapati AS, Smith AL, Chahrour C, Sevim O, Palmer DA, Bozhilov Y, Brown EJ, Olender L, Iskander D, Wang G, Rice S, O'Byrne S, Harman J, Ancliff P, Psaila B, Wilkinson AC, Morgan RG, Roberts IAG, Milne TA, Roy A · Blood 2026
    What this evidence cannot show

    Read: abstract only. Engineered translocation in human fetal liver CD34+ cells, not patient material; LIN28B is required for normal fetal B- and NK-lymphopoiesis in the same paper, so its loss removes the target compartment as well as the transforming event and the two cannot be separated by this design.

    Evidence that argues against this (1)
    • The independent literature disagrees with itself, which is the finding the same-source note could not have produced. In a dual-transgenic mouse co-expressing MLL-ENL and LIN28B, LIN28B IMPEDES progression of MLL-rearranged AML through compromised leukaemia-initiating-cell activity and suppression of MYB signalling, via stabilisation of MYBBP1A mRNA; the authors propose developmentally restricted LIN28B as a layer of protection against MYB-dependent AML. Mouse, myeloid, transgenic overexpression and a different fusion, so this may be a lineage difference rather than a contradiction - but neither result licenses reading a fetal transcriptome as evidence of cell of origin. This paper was cited nowhere in this graph before 2026-09-20. Eldeeb M et al. 2023
  4. E4established confidence 5 of 5: Multiple independent lines of evidence; treated as settled in the field.database

    The US prescribing information for REVUFORJ (revumenib) reports intact parathyroid hormone increased in 34% of patients (N=241; the denominator used to calculate individual laboratory rates varied from 139 to 240), phosphate increased in 51% and decreased in 25%, corrected calcium increased in 15% with 0% grade 3-4, and lists hyperparathyroidism under Endocrine disorders among clinically relevant adverse reactions occurring in under 20% of patients.

    REVUFORJ (revumenib) tablets, for oral use - US full prescribing information (NDA 218944) · Syndax Pharmaceuticals / US FDA · DailyMed / Drugs@FDA (NDA 218944) 2025
    What this evidence cannot show

    Fetched and read directly from DailyMed on 2026-09-20 rather than copied from the sibling entry that already carries this label, per the standing rule against second-hand identifiers. Laboratory abnormalities in a relapsed/refractory population on concurrent therapy with varying denominators; the label makes no causal attribution to menin inhibition. Cited here as the fact that falsifies a stale sentence in a counter-note, not as evidence about late effects.

    Evidence that argues against this (1)
    • A database or label fact is opposable on scope, and this one should be. A raised intact PTH over a median exposure of weeks to months in relapsed/refractory patients receiving several drugs is not the decades-long two-hit process that produces MEN1 parathyroid disease, and reading it as that process's early phase is exactly the like-for-like error the entries around it warn about. The label records an observation; it does not establish the mechanism the entry is about. Machens A et al. 2007
  5. E5strong confidence 4 of 5: Replicated in peer-reviewed work by more than one group.paper

    In Sprague-Dawley rats treated for 4, 8 and 12 weeks, dasatinib alone increased trabecular bone volume and thickness at the proximal tibia at levels comparable with a zoledronic-acid arm in the same experiment, with decreased osteoclast number and surface and decreased serum CTX-1 and no significant change in osteoblast markers.

    The tyrosine kinase inhibitor dasatinib dysregulates bone remodeling through inhibition of osteoclasts in vivo · Vandyke K, Dewar AL, Diamond P, Fitter S, Schultz CG, Sims NA, Zannettino ACW · Journal of Bone and Mineral Research 25(8):1759-70 2010
    What this evidence cannot show

    Read: abstract only. Healthy rats and physiologic bone turnover, no leukaemia, and a single dose and schedule for each agent, so it bounds the dasatinib/zoledronic-acid confound rather than resolving it.

    Evidence that argues against this (1)
    • The index paper's own TRAP-positive osteoclast counts in leukaemic mice do report zoledronic acid as the more potent osteoclast inhibitor, which is a different readout in a different model from trabecular morphometry in healthy rats. Neither measurement subsumes the other, and the honest statement is that the two agents' osteoclast effects overlap by an amount that the published head-to-heads do not agree on. Kotecha RS et al. 2025
  6. E6moderate confidence 3 of 5: One strong study, or several smaller consistent ones.paper

    Lineage switch in KMT2A-rearranged leukaemia occurs after CD19-directed therapy without any menin inhibitor: an infant with t(4;11)(q21;q23) ALL refractory to cytotoxic chemotherapy was treated with blinatumomab, cleared peripheral lymphoblasts rapidly, and then showed a marrow lineage switch to CD19-negative monoblastic AML, achieving remission on myeloid-directed chemotherapy.

    Lineage Switch in MLL-Rearranged Infant Leukemia Following CD19-Directed Therapy · Rayes A, McMasters RL, O'Brien MM · Pediatric Blood & Cancer 63(6):1113-5 2016
    What this evidence cannot show

    Read: abstract only. A single case report with no measurement of oncoprotein level, so it establishes that the phenomenon occurs without menin inhibition and nothing about frequency or cause. The bounding query `"lineage switch"[tiab] AND (KMT2A[tiab] OR MLL[tiab]) AND (leukemia[tiab] OR leukaemia[tiab])` returned 58 records on 2026-09-20.

    Evidence that argues against this (1)
    • A case report cannot establish a base rate, so it cannot by itself show that menin inhibitors are no more lineage-switch-prone than other interventions - which is what the note it was added to wants to argue. Establishing that needs stratified incidence across drug classes, which is not published, and `cell-state-under-menin-inhibition` should keep the claim at the level this evidence supports: lineage switch is not exclusive to menin inhibition. [Identifier note, and it belongs in this entry: the first draft of this citation block carried the DOI 10.1038/s41467-024-53920-z and the authors 'Chen Y, et al.', both written from recall while the correct record was one fetch away. Both were wrong - the DOI is 10.1038/s41467-024-53399-8 and the first author is Janssens DH - and they were caught by re-fetching before hand-back. A sweep about counter-evidence sourcing nearly shipped the exact error class it documents.] Janssens DH et al. 2024
  7. E7established confidence 5 of 5: Multiple independent lines of evidence; treated as settled in the field.dataset

    A mechanical scan of every counter-evidence note in the graph on 2026-09-20 found 6,374 counter_evidence items, of which 639 carry a PMID identical to their parent evidence item's PMID; of those 639, 39 store a title that is a strict prefix of the parent item's verified title, 3 counter_evidence items are bare strings rather than objects, and 15 are objects carrying no citation at all.

    Q40 counter-evidence quality sweep: mechanical scan of data/graph/nodes/*/*.json in the oncofusion knowledge graph · Q40-counter-evidence-quality (this analysis) · oncofusion-knowledge-graph, cycle 21 2026
    What this evidence cannot show

    Counts exclude data/graph/nodes/acetylation-cycle/, which another agent was writing during this sweep. The truncation test is a prefix test against the PARENT evidence item's title, which `verify-citations.py` validates against PubMed - it is not a fetch of each of the 39 titles, and a small number could be legitimate short forms rather than truncations. The count of 6,374 differs from the coordinator's census of 6,412 by the excluded folder and by the 18 malformed items.

    Evidence that argues against this (1)
    • A prefix relationship is suggestive of truncation and does not prove it: a shorter stored title could be a journal's short title, a subtitle-stripped form, or simply the correct title with the PARENT item carrying an over-long one - and one of the 39 rows (`pt-story-infant-all-kmt2a-aff1-hyperleukocytosis` E1) runs the other way, with the evidence title shorter than the counter-note's. Each of the 39 needs its title re-fetched from PubMed before it is called an error, and this entry records them as a queue, not as 39 defects. Q40-counter-evidence-quality (this analysis) 2026
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