Cancer Management and Research (Sep 2021)
Effective Immunosurveillance After Allogeneic Hematopoietic Stem Cell Transplantation in Acute Myeloid Leukemia
Abstract
Desiree Kunadt, Friedrich Stölzel Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, GermanyCorrespondence: Friedrich StölzelDepartment of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, Dresden, 01307, GermanyTel +49 351 458 19475Fax +49 351 458 5362Email [email protected]: The number of patients receiving allogeneic hematopoietic stem cell transplantation (alloHCT) has increased constantly over the last years due to advances in transplant technology development, supportive care, transplant safety, and donor availability. Currently, acute myeloid leukemia (AML) is the most frequent indication for alloHCT. However, disease relapse remains the main cause of therapy failure. Therefore, concepts of maintaining and, if necessary, reinforcing a strong graft-versus-leukemia (GvL) effect is crucial for the prognosis and long-term survival of the patients. Over the last decades, it has become evident that effective immunosurveillance after alloHCT is an entangled complex of donor-specific characteristics, leukemia-associated geno- and phenotypes, and acquired resistance mechanisms. Furthermore, adoption of effector cells such as natural killer (NK) cells, alloreactive and regulatory T-cells with their accompanying receptor repertoire, and cell–cell interactions driven by messenger molecules within the stem cell and the bone marrow niche have important impact. In this review of pre- and posttransplant elements and mechanisms of immunosurveillance, we highlight the most important mechanisms after alloHCT.Keywords: acute myeloid leukemia, AML, allogeneic stem cell transplantation, alloHCT, graft-versus-leukemia, GvL, relapse, immunosurveillance
