Can increased immunogenicity in chronic myeloid leukemia improve outcomes?

Expert Rev Hematol. 2019 Apr;12(4):225-233. doi: 10.1080/17474086.2019.1588105. Epub 2019 Mar 11.

Abstract

Chronic myeloid leukemia (CML) has long been thought to be the model disease for immunotherapy with its characteristic BCR-ABL fusion protein. Although targeted therapy using tyrosine kinase inhibitors (TKIs) is highly effective at inducing remission, most patients require life-long TKI to decrease the risk of relapse. In recent years, much effort has been devoted to finding ways to eliminate CML stem cells (LSCs); the source of disease persistence. Areas covered: In this review, the authors present recent immunologic findings pertinent to CML, vaccinations targeting leukemia antigens, interferon combination therapies, and other emerging strategies aimed at increasing immunogenicity and improving outcomes in patients with CML. Recent publications and abstracts found in Pubmed and hematology/oncology meetings related to these topics were identified and incorporated into this review. Expert commentary: Further understanding of the immune system and antigenic composition of LSCs has allowed for novel therapeutic development. Immunotherapies are effective at the malignant stem cell level and combining these approaches with TKI is a promising option. Despite ongoing challenges, it is increasingly recognized that a cure may be achievable through immunotherapies.

Keywords: CML; Chronic myeloid leukemia; immunogenicity; interferon with TKI; leukemia-associated antigens; tumor antigen-specific immunotherapy; vaccines.

Publication types

  • Review

MeSH terms

  • Animals
  • Antigens, Neoplasm / immunology
  • Cancer Vaccines / therapeutic use
  • Humans
  • Immunologic Factors / therapeutic use
  • Immunotherapy / methods*
  • Interferons / therapeutic use
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / immunology
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / therapy*
  • Protein Kinase Inhibitors / therapeutic use
  • Protein-Tyrosine Kinases / antagonists & inhibitors

Substances

  • Antigens, Neoplasm
  • Cancer Vaccines
  • Immunologic Factors
  • Protein Kinase Inhibitors
  • Interferons
  • Protein-Tyrosine Kinases