Unlocking the Power of Immune Microenvironment in AML Therapy: Current Insight and Future Prospects

In recent years, significant progress has been made in elucidating the pathogenic mechanisms underlying acute myeloid leukemia (AML), leading to the accelerated discovery of new therapeutics and innovative treatment strategies. There is growing interest in understanding the central role of the immune system in the development, progression, and recurrence of AML. This expanded understanding has shed light on the intricate mechanisms of immunologic evasion and systemic tolerance orchestrated by AML blasts. The remarkable successes achieved with immune-based therapies that harness the power of T cells in solid tumors and certain hematologic malignancies have led to extensive research efforts in the field of AML treatment. These efforts have resulted in a spectrum of immunotherapies ranging from immune checkpoint inhibitors and monoclonal antibodies to T-cell therapies driven by engineered antigen receptors. Despite these advances, resistance to conventional chemotherapy and the persistence of leukemia stem cells, which contribute significantly to relapse, remain major obstacles in the search for effective AML treatment. Conventional consolidation chemotherapy, which is often associated with acute and chronic side effects, is rarely a viable option, especially for elderly patients. In response to these challenges, ongoing clinical trials are evaluating immune-based therapies in various clinical settings, including initial treatment, relapsed/refractory (R/R) cases, and treatment after allogeneic stem cell transplantation. This comprehensive review provides a scientific examination of the evolving landscape of AML therapy, underscored by the promising field of immunotherapeutic approaches. By highlighting both the opportunities and obstacles along the way, we seek to illuminate the path to improved outcomes and the ultimate conquest of AML.