IntroductionAcute myeloid leukemia (AML) with unfavorable cytogenetics has a poor outcome, even when treated with aggressive chemotherapy. 1,2 With chemoradiotherapy and hematopoietic stem cell transplantation, a graft-versus-leukemia effect can be observed even in patients with unfavorable cytogenetics. 3 Although donor lymphocyte infusion (DLI) given as adoptive immunotherapy after hematopoietic stem cell transplantation has improved the outcomes of certain types of leukemia, 4-6 for patients with AML, DLI has been less effective likely due at least in part to its rapid tumor progression. 7,8 As a result of the anti-AML effects of DLI and with the observation that antitumor-specific cytotoxic T cells (CTLs) can be generated in vitro from cancer patients, adoptive CTL therapy has been proposed for decades as cancer treatment. [9][10][11][12][13][14] However, the adoptive transfer of anti-AML-reactive CTLs alone has not solved the problem of AML disease recurrence. 15 In patients with chronic myelogenous leukemia, a complete remission was achieved in a patient with accelerated-phase disease after adoptive treatment with leukemia-reactive CTLs. 16 In rodents with minimal disease, CTL adoptive transfer also has not been uniformly curative despite the early transfer of large numbers of anti-AML-reactive CTLs. 17,18 Enhancing CTL function in vivo via the administration of supportive cytokine therapy such as interleukin-2 (IL-2), 20 and interferons 21 can improve antitumor efficacy but has been associated with substantial side effects. Therefore, recent studies have focused on eliminating the suppressive factors in the tumor environment to circumvent CTLs from inhibition. 22,23 T-regulatory cells (Tregs) are important regulators of immune responses in transplantation, 24,25 allergy, 26,27 and autoimmune disease. 28,29 In AML patients, the frequency of Tregs was noted to be significantly higher compared with healthy persons, likely due to increased proliferation. 30 Human AML cells have been noted to favor the conversion of CD4 ϩ 25 Ϫ T cells into Tregs via modulation of tryptophan catabolism. 31 Tregs that have been recruited to, or converted either before migration into or within the tumor environment, can have a profound inhibition on T cell-mediated immune response. 32 Multiple mechanisms have been defined to be responsible for the suppression, including secretion of transforming growth factor- 33,34 and IL-10, 33,34 as well as inhibition of dendritic cell (DC) maturation. 33,35 Despite the great potential for Treg depletion in cancer therapies, the efficacy has been limited to prophylactic settings where depletion of Tregs is given before the establishment of tumor. 36,37 The present studies were undertaken to determine whether endogenous Tregs present at the site of AML dissemination constrained the antileukemia efficacy of anti-AML CTL adoptive transfer in a rodent model as a prelude to future clinical trials. We observed that AML progression correlated with increased Tregs at the sites of AML disease. Incr...