The adaptive immune system can be a potent defense mechanism against cancer; however, it is often hampered by immune suppressive mechanisms in the tumor microenvironment. Coinhibitory molecules expressed by tumor cells, immune cells, and stromal cells in the tumor milieu can dominantly attenuate T-cell responses against cancer cells. Today, a variety of coinhibitory molecules, including cytotoxic T lymphocyte-associated antigen-4, programmed death-1, B and T lymphocyte attenuator, LAG3, T-cell immunoglobulin and mucin domain 3, and CD200 receptor, have been implicated in immune escape of cancer cells. Sustained signaling via these coinhibitory molecules results in functional exhaustion of T cells, during which the ability to proliferate, secrete cytokines, and mediate lysis of tumor cells is sequentially lost. In this review, we discuss the influence of coinhibitory pathways in suppressing autologous and allogeneic T cell-mediated immunity against hematologic malignancies. In addition, promising preclinical and clinical data of immunotherapeutic approaches interfering with negative cosignaling, either as monotherapy or in conjunction with vaccination strategies, are reviewed. Numerous studies indicate that coinhibitory signaling hampers the clinical benefit of current immunotherapies. Therefore, manipulation of coinhibitory networks is an attractive adjuvant immunotherapeutic intervention for hematologic cancers after standard treatment with chemotherapy and hematopoietic stem cell transplantation. (Blood. 2012;120(4): 728-736)
IntroductionDespite the powerful aspects of immune reactions, most often tumor cells are able to evade immune recognition and destruction. Mechanisms exploited by tumor cells to escape T cell-mediated immunity include disruption of antigen presentation, downregulation of HLA molecules, secretion of immune suppressive cytokines, as well as recruitment of regulatory T cells (T REG ) and myeloid-derived suppressor cells. 1 In the last decade, another powerful immune suppressive mechanism gained much attention: the repressive action of coinhibitory molecules. 2 Activation of T cells is predominantly dependent on both costimulatory and coinhibitory members, including members of the B7/ CD28 family. The balance between positive and negative cosignals determines the functionality of T cells during immunity and tolerance. In addition to the native role of cosignaling, tumor cells can evade immune control by down-regulating costimulatory molecules, such as CD80 and CD86, and up-regulating various coinhibitory ligands, thereby limiting the therapeutic potential of current immunotherapy against cancer.Standard treatment for hematologic cancers includes chemotherapy and radiotherapy, which reduce tumor burden and can induce long-term remission. Moreover, in the past years, new therapeutics, including imatinib, dasatinib, rituximab, bortezomib, and lenalidomide, have been developed that target tumor cells. However, drug resistance and relapse remain major problems. In addition, cellular immunotherapy ...