Targeting the minimal residual disease in acute myeloid leukemia: the role of alloreactive natural killer cells

Abstract

SUMMARY The clinical results of AML patients, especially if elderly, are particularly dismal, although the achievement of CR with MRD after combined chemotherapy appears as possible in a good fraction of patients. Indeed, the persistence of MRD leads to progression and patients ultimately die. For these reasons, alternative approaches for the prevention of relapse in CR patients are necessary and are currently under active investigation. Allogeneic stem cell transplantation (SCT), which combines the cytotoxic effect of conditioning regimen with adoptive immunotherapy, has been shown to offer a clear advantage in terms of relapse prevention, thus providing the proof-of-principle of the capacity of immune cells of eradicating MRD. However, such approach has several and important limitations and is not applicable to all the patients, especially if elderly. In this scenario, the role of immunological therapies in the post-remission management of adult AML patients, such as NK therapy, beside the SCT setting, have been recently exploited with promising results in terms of immunological and clinical responses.