Over the last decades, significant improvements in reducing the toxicities of allogeneic hematopoietic cell transplantation (allo-HCT) have widened its use as consolidation or salvage therapy for high-risk hematological malignancies. Nevertheless, relapse of the original malignant disease remains an open issue with unsatisfactory salvage options and limited rationales to select among them. In the last years, several studies have highlighted that relapse is often associated with specific genomic and nongenomic mechanisms of immune escape. In this review we summarize the current knowledge about these modalities of immune evasion, focusing on the mechanisms that leverage antigen presentation and pathologic rewiring of the bone marrow microenvironment. We present examples of how this biologic information can be translated into specific approaches to treat relapse, discuss the status of the clinical trials for patients who relapsed after a transplant, and show how dissecting the complex immunobiology of allo-HCT represents a crucial step toward developing new personalized approaches to improve clinical outcomes.
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ONCOGENIC SIGNALING AND IMMUNE EVASION IN HEMATOLOGIC MALIGNANCIES|
June 27, 2024
Tricking the trickster: precision medicine approaches to counteract leukemia immune escape after transplant
Annalisa Tameni,
Annalisa Tameni
1Unit of Immunogenetics, Leukemia Genomics and Immunobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
2Vita-Salute San Raffaele University, Milan, Italy
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Cristina Toffalori,
Cristina Toffalori
1Unit of Immunogenetics, Leukemia Genomics and Immunobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
2Vita-Salute San Raffaele University, Milan, Italy
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Luca Vago
Luca Vago
1Unit of Immunogenetics, Leukemia Genomics and Immunobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
2Vita-Salute San Raffaele University, Milan, Italy
3Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Blood (2024) 143 (26): 2710–2721.
Article history
Submitted:
December 27, 2023
Accepted:
April 30, 2024
First Edition:
May 10, 2024
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Citation
Annalisa Tameni, Cristina Toffalori, Luca Vago; Tricking the trickster: precision medicine approaches to counteract leukemia immune escape after transplant. Blood 2024; 143 (26): 2710–2721. doi: https://doi.org/10.1182/blood.2023019962
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