CAR T-celtherapie bij pediatrisch AML: klinische ervaringen, uitdagingen en toekomstige strategieën

Acute myeloid leukemia (AML) is the second most common leukemia in children. Although survival rates have improved over several decades, for patients with high-risk or chemotherapy-refractory AML, hematopoietic stem cell transplantation (HSCT) remains the only curative therapy. HSCT provides immune-mediated control of residual leukemia through the graft-versus-leukemia effect, underscoring the importance of allogeneic immune responses in achieving durable remission for children with AML. Chimeric antigen receptor (CAR) T cells are genetically engineered T lymphocytes that express synthetic receptors combining antigen recognition with T cell activation and costimulatory signaling domains. By recognizing tumor antigens independently of MHC, CAR T cells can mediate potent cytotoxicity. CD19-directed CAR T cells have transformed outcomes for pediatric patients with relapsed or refractory B cell acute lymphoblastic leukemia but translating CAR T cell therapy to AML has proven challenging. This review summarizes clinical experiences to date with AML-directed CAR T cells, highlighting pediatric data. We also review barriers to successful translation of AML CAR T cell therapy that have been identified in basic and translational studies. Finally, we discuss emerging strategies to improve efficacy, including advanced CAR designs, optimized antigen and patient selection, and rational combination approaches.