Chronic myeloid leukemia in a global context: confirmatory findings and novel discoveries from a refined Japanese Cohort.

Treatment-free remission (TFR) has become a major therapeutic goal in patients with chronic myeloid leukemia (CML). Japanese clinical and translational studies have contributed substantially to this field. Here, we review Japanese studies and distinguish between findings that corroborate internationally established concepts and those that provide novel biological insights. Confirmatory studies demonstrated the feasibility of TFR after sustained deep molecular response (DMR), established DMR duration as a more important determinant of durable remission than rapid attainment, and confirmed the feasibility of repeated discontinuation attempts. Together, these findings support the concept that sustained DMR provides sufficient time for both continued reduction of residual disease burden and progressive restoration of immune surveillance. Beyond these observations, Japanese studies have provided important mechanistic insights into leukemic stem cell persistence, dasatinib-associated immune remodeling, inherited immunogenetic determinants of TFR, adaptive immune surveillance, and practical biomarkers of TFR eligibility. Collectively, these findings support an integrated model of TFR in which inherited immunogenetic background, immune competence, leukemic stem cell persistence, and treatment history interact dynamically to determine clinical outcomes. Ongoing studies, including ASSET-CML and ASC4Edit Japan, may further translate these insights into more individualized and durable TFR strategies.