The immune system is important for elimination of residual leukemic cells during acute myeloid leukemia (AML) therapy. Anti-leukemia immune response can be inhibited by various mechanisms leading to immune evasion and disease relapse. Selected markers of immune escape were analyzed on AML cells from leukapheresis at diagnosis (N = 53). Hierarchical clustering of AML immunophenotypes yielded distinct genetic clusters. In the absence of DNMT3A mutation, NPM1 mutation was associated with decreased HLA expression and low levels of other markers (CLIP, PD-L1, TIM-3). Analysis of an independent cohort confirmed decreased levels of HLA transcripts in patients with NPM1 mutation. Samples with combined NPM1 and DNMT3A mutations had high CLIP surface amount suggesting reduced antigen presentation. TIM-3 transcript correlated not only with TIM-3 surface protein but also with CLIP and PD-L1. In our cohort, high levels of TIM-3/PD-L1/CLIP were associated with lower survival. Our results suggest that AML genotype is related to blast immunophenotype, and that high TIM-3 transcript levels in AML blasts could be a marker of immune escape. Cellular pathways regulating resistance to the immune system might contribute to the predicted response to standard therapy of patients in specific AML subgroups and should be targeted to improve AML treatment.

Clinical Department Institute of Hematology and Blood Transfusion Prague Czech Republic

Department of Apheresis Institute of Hematology and Blood Transfusion Prague Czech Republic

Department of Cytogenetics Institute of Hematology and Blood Transfusion Prague Czech Republic

Department of Gene Immunotherapy Research Institute of Hematology and Blood Transfusion Prague Czech Republic

Department of Proteomics Institute of Hematology and Blood Transfusion Prague Czech Republic

Institute of Clinical and Experimental Hematology 1st Faculty of Medicine Charles University Prague Czech Republic

Medical Clinic 1 Division Hematology Cell Therapy and Medical Oncology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany

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