Guarnera Luca, Santinelli Enrico, Galossi Elisa, Cristiano Antonio, Fabiani Emiliano, Falconi Giulia, Voso Maria Teresa
Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.
Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Exp Hematol. 2024 Jan;129:104118. doi: 10.1016/j.exphem.2023.09.005. Epub 2023 Sep 22.
Acute myeloid leukemia (AML) is a disease with a dismal prognosis, mainly affecting the elderly. In recent years, new drugs have improved life expectancy and quality of life, and a better understanding of the genetic-molecular nature of the disease has shed light on previously unknown aspects of leukemogenesis. In parallel, increasing attention has been attracted to the complex interactions between cells and soluble factors in the bone marrow (BM) environment, collectively known as the microenvironment. In this review, we discuss the central role of the microenvironment in physiologic and pathologic hematopoiesis and the mechanisms of senescence, considered a fundamental protective mechanism against the proliferation of damaged and pretumoral cells. The microenvironment also represents a fertile ground for the development of myeloid malignancies, and the leukemic niche significantly interacts with drugs commonly used in AML treatment. Finally, we focus on the role of the microenvironment in the engraftment and complications of allogeneic hematopoietic stem cell transplantation, the only curative option in a conspicuous proportion of patients.
急性髓系白血病（AML）是一种预后不佳的疾病，主要影响老年人。近年来，新药改善了预期寿命和生活质量，对该疾病遗传分子本质的深入了解也为白血病发生中以前未知的方面带来了曙光。与此同时，骨髓（BM）微环境中细胞与可溶性因子之间的复杂相互作用，即所谓的微环境，受到了越来越多的关注。在这篇综述中，我们讨论了微环境在生理和病理造血中的核心作用以及衰老机制，衰老被认为是一种针对受损和肿瘤前细胞增殖的基本保护机制。微环境也是髓系恶性肿瘤发展的温床，白血病龛与AML治疗中常用药物有显著相互作用。最后，我们重点关注微环境在异基因造血干细胞移植植入和并发症中的作用，异基因造血干细胞移植是相当一部分患者唯一的治愈选择。
