Immune escape in AML relapse after Allo-HSCT: a double perspective of active leukemic offense and passive immune resistance

Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) represents a potentially curative modality for acute myeloid leukemia (AML), disease relapse remains a frequent complication associated with poor prognosis and constitutes the leading cause of mortality following transplantation. This review adopted a novel dual-perspective framework to reveal the immune escape mechanisms that underpin AML relapse following allo-HSCT. Within the complex interplay between AML and immune effector cells, leukemia cells employ a dual strategy: the offensive action via fostering an immunosuppressive microenvironment and upregulating immune checkpoint ligands, and the passive defensive maneuver through dysregulated human leukocyte antigen (HLA) expression to evade immune recognition.