A Killer Disarmed: Natural Killer Cell Impairment in Myelodysplastic Syndrome

Myelodysplastic syndrome (MDS) treatment remains a big challenge due to the heterogeneous nature of the disease and its ability to progress to acute myeloid leukemia (AML). The only curative option is allogeneic hematopoietic stem cell transplantation (HSCT), but most patients are unfit for this procedure and are left with only palliative treatment options, causing a big unmet need in the context of this disease. Natural killer (NK) cells are attractive candidates for MDS immunotherapy due to their ability to target myeloid leukemic cells without prior sensitization, and in recent years we have seen an arising number of clinical trials in AML and, recently, MDS. NK cells are reported to be highly dysfunctional in MDS patients, which can be overcome by adoptive NK cell immunotherapy or activation of endogenous NK cells. Here, we review the role of NK cells in MDS, the contribution of the tumor microenvironment (TME) to NK cell impairment, and the most recent data from NK cell-based clinical trials in MDS.

Automated summary

The treatment of myelodysplastic syndrome (MDS) is challenging due to its heterogeneous nature and ability to progress to acute myeloid leukemia (AML). Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative option, but most patients cannot undergo this procedure. Natural killer (NK) cells have shown promise as immunotherapeutic candidates for MDS. However, NK cells in MDS patients are highly dysfunctional, which can be overcome by adoptive NK cell immunotherapy or activation of endogenous NK cells. This review explores the role of NK cells in MDS and the recent data from NK cell-based clinical trials.