Leukemic fitness predicts treatment-free remission and guides adaptive therapy in chronic myeloid leukemia

Leukemic fitness in chronic myeloid leukemia is linked to treatment-free remission in 75 DESTINY trial patients, with values above one making cure unstable and below one making it stable.

• Why it matters: Current models need many parameters and immune measurements, and clinicians cannot reliably predict who will relapse after stopping tyrosine kinase inhibitors.
• What they did: The authors reduced a mechanistic immune–leukemia model to two equations by eliminating the immune compartment, dropping parameters from fourteen to eight, then fitted it to 75 DESTINY patients.
• The result: Leukemic fitness estimated from routine time courses up to cessation (including dose reduction) predicts outcome, and discrimination improves with six months post-cessation data; it also guides adaptive therapy strategies.