Harnessing the immune system to treat solid tumors has been extraordinarily successful in recent years. The success of immunotherapy in patients with haematological malignancies has mainly been limited to B-cell neoplasms with bispecific T-cell engager (BiTE) for ALL, chimeric antigen receptor (CAR) T cells for ALL and lymphoma and immune checkpoint inhibitors (ICPIs) for lymphoma. Whereas immunotherapy, in the form of allogeneic stem cell transplantation (allo-SCT), has a major role in the treatment algorithm for AML, not every patient is a transplant candidate. In the past decade, we have made significant progress in understanding the biology of both AML and ALL, including studying the underlying immune systems at play. This understanding has led to the investigation of several innovative T-cell-based treatment strategies to treat these diseases.
Novel T-cell-based strategies such as CAR-T and T-cell engaging antibody constructs have found more success in B-cell malignancies, perhaps due to a recognition of suitable targets. However, for B-cell ALL, challenges still exist. Larger studies with longer follow-up are needed for adults with B-cell ALL treated with CAR-T therapy. This also needs to be matched with real-world data given the financial and logistical challenges associated with these therapies. Furthermore, whereas response rates for these therapies are high, the durability is questionable. There is a need to identify biomarkers to predict response as well strategies to consolidate response.
The challenges listed for ALL also apply to AML. However, the main reason that immunotherapy for AML is still primitive is the inability to identify a suitable target. Preclinical data has translated into early phase trials for AML, but there is still a long way to go. Identifying the relevant biomarkers along with the appropriate disease setting (newly diagnosed, maintenance, low-burden disease or relapse) are areas of ongoing investigation and will guide future trials. Lastly, novel therapies bring with them unique toxicities and diagnosing and treating immune-mediate adverse effects in AML and ALL need to be better characterized.
In this Research Topic, we welcome original research and review articles focusing on, but not limited to, the following sub-topics:
- Better understanding the immune landscape of AML and ALL
- Pre-clinical or clinical data of immunotherapy in AML or ALL
- Innovative treatment strategies (combination therapy, appropriate disease setting, etc)
- Management of immune-mediates toxicities
- Real-world evidence of immunotherapy in AML and ALL
- Biological, financial and logistical challenges of immunotherapy for acute leukemia
Topic Editor Dr. Omer Jamy is on the advisory board for Ascentage. Dr. Joshua Zeidner has received consulting fees from AbbVie, Bristol Myers Squibb, Daiichi Sankyo, Foghorn, Gilead, Immunogen, Novartis, Sellas, Servier, and Sumitomo Dainippon, and receives research support from AbbVie, Arog, Astex, Jazz, Gilead, Loxo, Merck, Newave, Shattuck Labs, Stemline, Sumitomo Dainippon, and Takeda. The other Topic Editors declare no competing interests with regard to the Research Topic subject.
Harnessing the immune system to treat solid tumors has been extraordinarily successful in recent years. The success of immunotherapy in patients with haematological malignancies has mainly been limited to B-cell neoplasms with bispecific T-cell engager (BiTE) for ALL, chimeric antigen receptor (CAR) T cells for ALL and lymphoma and immune checkpoint inhibitors (ICPIs) for lymphoma. Whereas immunotherapy, in the form of allogeneic stem cell transplantation (allo-SCT), has a major role in the treatment algorithm for AML, not every patient is a transplant candidate. In the past decade, we have made significant progress in understanding the biology of both AML and ALL, including studying the underlying immune systems at play. This understanding has led to the investigation of several innovative T-cell-based treatment strategies to treat these diseases.
Novel T-cell-based strategies such as CAR-T and T-cell engaging antibody constructs have found more success in B-cell malignancies, perhaps due to a recognition of suitable targets. However, for B-cell ALL, challenges still exist. Larger studies with longer follow-up are needed for adults with B-cell ALL treated with CAR-T therapy. This also needs to be matched with real-world data given the financial and logistical challenges associated with these therapies. Furthermore, whereas response rates for these therapies are high, the durability is questionable. There is a need to identify biomarkers to predict response as well strategies to consolidate response.
The challenges listed for ALL also apply to AML. However, the main reason that immunotherapy for AML is still primitive is the inability to identify a suitable target. Preclinical data has translated into early phase trials for AML, but there is still a long way to go. Identifying the relevant biomarkers along with the appropriate disease setting (newly diagnosed, maintenance, low-burden disease or relapse) are areas of ongoing investigation and will guide future trials. Lastly, novel therapies bring with them unique toxicities and diagnosing and treating immune-mediate adverse effects in AML and ALL need to be better characterized.
In this Research Topic, we welcome original research and review articles focusing on, but not limited to, the following sub-topics:
- Better understanding the immune landscape of AML and ALL
- Pre-clinical or clinical data of immunotherapy in AML or ALL
- Innovative treatment strategies (combination therapy, appropriate disease setting, etc)
- Management of immune-mediates toxicities
- Real-world evidence of immunotherapy in AML and ALL
- Biological, financial and logistical challenges of immunotherapy for acute leukemia
Topic Editor Dr. Omer Jamy is on the advisory board for Ascentage. Dr. Joshua Zeidner has received consulting fees from AbbVie, Bristol Myers Squibb, Daiichi Sankyo, Foghorn, Gilead, Immunogen, Novartis, Sellas, Servier, and Sumitomo Dainippon, and receives research support from AbbVie, Arog, Astex, Jazz, Gilead, Loxo, Merck, Newave, Shattuck Labs, Stemline, Sumitomo Dainippon, and Takeda. The other Topic Editors declare no competing interests with regard to the Research Topic subject.