Antigen-specific immunotherapies have emerged as important components of curative treatment algorithms for many cancers. In acute myeloid leukemia (AML), success has been less obvious. Nonetheless, among the few drugs shown to improve survival in recent randomized trials is the CD33 antibody-drug conjugate gemtuzumab ozogamicin. Significant antileukemic activity is also well documented for radioimmunoconjugates targeting CD33, CD45, or CD66. These therapeutics can intensify conditioning before hematopoietic cell transplantation, but their effect on patient outcomes needs clarification. Emerging data now suggest clinical antileukemic activity of several novel antibodies and perhaps some adoptive T-cell immunotherapies and vaccines. In parallel, numerous other agents targeting a wider variety of antigens are currently being explored. However, the antigenic heterogeneity characteristic of AML is a considerable limitation for all these therapeutics, and many important questions related to the ideal target antigen(s), disease situation in which to use these therapies, most suitable patient populations, exact treatment modalities, and details of supportive care needs remain open. Addressing such questions in upcoming studies will be required to ensure that antigen-directed therapies become an effective tool in AML, a disease for which outcomes with standard "3 ϩ 7"-based chemotherapy have remained unsatisfactory in many patients.
Learning Objectives• To gain an overview of current clinical results with antigenspecific immunotherapies for acute myeloid leukemia • To become familiar with recent advances and evolving treatment concepts in the field of antigen-specific immunotherapy for acute myeloid leukemia and to appreciate the challenges in the clinical translation of these therapeutic strategies Conceptually, antigen-specific immunotherapies offer a versatile means of eliminating tumor cells with limited nonspecific toxicities. For many human cancers, including some hematological malignancies, such therapies have emerged as important components of curative treatment algorithms. 1-3 Success has been more modest for acute myeloid leukemia (AML). Nonetheless, among the few drugs that have shown to improve survival in recent randomized trials is the CD33 antibody-drug conjugate gemtuzumab ozogamicin (GO). The clinical experience with GO provides the strongest glimpse thus far of the potential value of antigen-targeted therapies for AML. Here, we review the results of efforts with antibodies and other antigen-directed passive and active immunotherapies in AML and summarize evolving treatment strategies for this disease.