急性髓细胞白血病（AML）是一种预后不良的疾病，主要影响老年人。近年来，新药物改善了预期寿命和生活质量，并对疾病的遗传-分子本质有了更好的理解，揭示了以前未知的白血病发生机制。与此同时，对骨髓微环境中细胞和可溶性因子之间复杂相互作用的关注也越来越多，这被称为微环境。本综述讨论了微环境在生理和病理造血过程中的中心作用及衰老机制，衰老被认为是一种基本的防护机制，可以阻止损伤和前恶性细胞的增殖。微环境还为髓系恶性肿瘤的发展提供了肥沃的土壤，并且白血病生态位与AML治疗中常用的药物有着重要的相互作用。最后，我们重点关注微环境在异基因造血干细胞移植的植入和并发症中的作用，这是一大部分患者唯一的治愈选择。版权所有 © 2023 Elsevier Inc. 发布。

Acute myeloid leukemia (AML) is a disease with dismal prognosis, mainly affecting elderly individuals. 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 environment, collectively known as 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 pre-tumoral 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.Copyright © 2023. Published by Elsevier Inc.