title: [An immunological approach to acute myeloid leukaemia].
abstract: BACKGROUND
  Acute myeloid leukaemia (AML) is the second haematological malignancy in the paediatric population, and one of the leading causes of childhood cancer mortality. Survival is currently around 60%, with no improvement in last decades, suggesting that new therapeutic approaches are needed. The anti-leukaemia effect mediated by the lymphocytes and natural killer (NK) cells of the immune system has been established in haematopoietic stem cell transplantation, and also as adoptive immunotherapy after consolidation chemotherapy schemes.
  
  
  METHODS
  A retrospective study was conducted on the clinical characteristics of patients diagnosed and treated for AML in our centre during 1996-2014. The mean fluorescence intensities of HLA-I, MICA/B and ULBP1-4, ligands for NK cell receptors, were also analysed in ten new diagnosed leukaemia cases, five myeloid and five lymphoid.
  
  
  RESULTS
  A total of 67 patients were used in this analysis. With a median follow up of 25 months, the event-free survival was 62% (95% CI: 55-67). Secondary AML, non-M3 phenotype, and the absence of favourable cytogenetic markers had a lower survival. The probability of relapse was 38% (95% CI: 31-45). The expression of HLA-I and ULBP-4 was significantly lower in myeloid than in lymphoid blast cells.
  
  
  CONCLUSIONS
  Our clinical results are similar to those described in the literature. Survival did not significantly change in recent decades, and the likelihood of relapse remains high. Myeloid blasts might be more susceptible to the cytotoxicity of NK cells through their lower expression of HLA-I. NK therapy strategies in minimal disease situation could be effective, as reported by other groups.
authors.affiliation: Unidad de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España.
authors.forename: B
authors.initials: B
authors.lastname: González
authors.affiliation: Unidad de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España.
authors.forename: D
authors.initials: D
authors.lastname: Bueno
authors.affiliation: Unidad de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España.
authors.forename: P M
authors.initials: PM
authors.lastname: Rubio
authors.affiliation: Unidad de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España.
authors.forename: S
authors.initials: S
authors.lastname: San Román
authors.affiliation: Unidad de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España.
authors.forename: D
authors.initials: D
authors.lastname: Plaza
authors.affiliation: Unidad de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Sastre
authors.affiliation: Unidad de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España.
authors.forename: P
authors.initials: P
authors.lastname: García-Miguel
authors.affiliation: Grupo de Investigación Clínica, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Fernández
authors.affiliation: Grupo de Inmunidad Innata y Cáncer, Instituto de Investigación de la Paz (IdiPaz), Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Valentín
authors.affiliation: Unidad de Hemato-Oncología Pediátrica, Hospital Montepríncipe, Madrid, España.
authors.forename: I
authors.initials: I
authors.lastname: Martínez
authors.affiliation: Unidad de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España; Grupo de Inmunidad Innata y Cáncer, Instituto de Investigación de la Paz (IdiPaz), Madrid, España. Electronic address: aperezmartinez@salud.madrid.org.
authors.forename: A
authors.initials: A
authors.lastname: Pérez-Martínez
mesh_terms: D002352:Carrier Proteins / Q000235:genetics; D002648:Child; D005805:Genes, MHC Class I; D015395:Histocompatibility Antigens Class I / Q000235:genetics; D006801:Humans; D007694:Killer Cells, Natural / Q000166:cytology; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000276:immunology*; D008565:Membrane Proteins / Q000235:genetics; D010641:Phenotype; D012189:Retrospective Studies
chemical_list: D002352:Carrier Proteins; D015395:Histocompatibility Antigens Class I; D008565:Membrane Proteins; C488760:RAET1E protein, human
keywords: Acute myeloid leukaemia; Células natural killer; Human leucocyte antigen class I (HLA-I); Leucemia mieloblástica aguda; Major histocompatibility complex (MHC) class-I related chain A/B (MICA/B); Natural killer cells; UL16-binding proteins 1-4 (ULBP 1-4)