急性髓系白血病 (AML) 是一种异质性疾病，其特征是骨髓 (BM) 和外周血 (PB) 中未成熟的髓系细胞扩张，导致正常造血功能失败和危及生命的血细胞减少。异基因造血干细胞移植（allo-HCT）是一种具有治愈潜力的既定疗法。然而，移植后复发很常见，且预后不良，是异基因 HCT 后死亡的主要原因。最初成功的同种异体 HCT 后出现的复发表明供体免疫系统首先能够控制白血病，并在后期发展出逃避策略以逃避免疫监视。在这篇综述中，我们首先全面概述了 allo-HCT 后 AML 免疫逃逸的最新知识，包括 HLA 失调、免疫检查点的改变以及导致免疫抑制肿瘤微环境的变化。在第二部分中，我们从实验室到临床划清界限，并阐明治疗策略中尚未利用复发性 AML 的免疫逃逸机制。最后，我们展望了新兴技术如何帮助改善这些患者的治疗，并阐明潜在的新治疗方案。© 2023。作者。

Acute myeloid leukemia (AML) is a heterogeneous disease characterized by the expansion of immature myeloid cells in the bone marrow (BM) and peripheral blood (PB) resulting in failure of normal hematopoiesis and life-threating cytopenia. Allogeneic hematopoietic stem cell transplantation (allo-HCT) is an established therapy with curative potential. Nevertheless, post-transplant relapse is common and associated with poor prognosis, representing the major cause of death after allo-HCT. The occurrence of relapse after initially successful allo-HCT indicates that the donor immune system is first able to control the leukemia, which at a later stage develops evasion strategies to escape from immune surveillance. In this review we first provide a comprehensive overview of current knowledge regarding immune escape in AML after allo-HCT, including dysregulated HLA, alterations in immune checkpoints and changes leading to an immunosuppressive tumor microenvironment. In the second part, we draw the line from bench to bedside and elucidate to what extend immune escape mechanisms of relapsed AML are yet exploited in treatment strategies. Finally, we give an outlook how new emerging technologies could help to improve the therapy for these patients, and elucidate potential new treatment options.© 2023. The Author(s).