Immune Escape of Acute Myeloid Leukemia after Transplantation

Abstract Acute myeloid leukemia (AML) is the main indication for allogeneic hematopoietic cell transplantation, but relapse is common because of chemotherapy resistance and immune escape. We discuss the mechanisms of AML immune evasion including loss or downregulation of MHC class I and II, reduced tumor necrosis factor–related apoptosis-inducing ligand (TRAIL) receptor expression, inhibitory metabolite production, inhibitory ligand expression, impaired proinflammatory cytokine production, and AML niche alterations. Understanding and targeting these mechanisms could enhance outcomes for patients with AML undergoing allogeneic hematopoietic cell transplantation and immunotherapies. Significance: We discuss the mechanisms of AML immune evasion including loss or downregulation of MHC class I and II, reduced TRAIL receptor expression, inhibitory metabolite production, inhibitory ligand expression, impaired proinflammatory cytokine production, and AML niche alterations.