Blasts in context: the impact of the immune environment on acute myeloid leukemia prognosis and treatment

Acute myeloid leukemia (AML) is a cancer that originates from the bone marrow (BM). Under physiological conditions, the bone marrow supports the homeostasis of immune cells and hosts memory lymphoid cells. In this review, we summarize our present understanding of the role of the immune microenvironment on healthy bone marrow and on the development of AML, with a focus on T cells and other lymphoid cells. The types and function of different immune cells involved in the AML microenvironment as well as their putative role in the onset of disease and response to treatment are presented. We also describe how the immune context predicts the response to immunotherapy in AML and how these therapies modulate the immune status of the bone marrow. Finally, we focus on allogeneic stem cell transplantation and summarize the current understanding of the immune envi-ronment in the post-transplant bone marrow, the factors associated with immune escape and relevant strategies to prevent and treat relapse.

Automated summary

In this review, the authors summarize the role of the immune microenvironment in healthy bone marrow and AML development, focusing on T cells and other lymphoid cells. They discuss the types and function of immune cells in the AML microenvironment, as well as their potential role in disease onset and treatment response. The review also examines how the immune context predicts the response to immunotherapy in AML and how these therapies modulate the immune status of the bone marrow. Finally, the authors focus on allogeneic stem cell transplantation and discuss the immune environment in the post-transplant bone marrow, factors associated with immune escape, and strategies to prevent and treat relapse.