Immunotherapy in acute myeloid leukemia: The antibodies, TriKEs, and CARs on the arduous road to cure

Acute myeloid leukemia (AML) is a complex, heterogeneous and aggressive hematopoietic clonal disorder with limited curative options beyond allogeneic stem cell transplantation. The disease presents significant challenges due to high relapse rates resistance to chemotherapy, and the immunosuppressive tumor microenvironment. The immune system plays an important role in leukemia survival and resistance. Various immunotherapeutic approaches, ranging from the use of monoclonal antibodies, antibody-drug conjugates (ADCs), bispecific T-cell engagers (BiTE's), chimeric antigen receptor T (CAR-T) cells, vaccines and therapeutic infusions of NK cells, are currently being tested with promising, yet conflicting results. We review the various types of immunotherapies in pre-clinical and clinical development and discuss how best to use them in clinical practice from the point of view of a clinical hematologist.