Figure 1.

Summary of leukemic stem cell (LSC) distinctive features. LSC are characterized by phenotypic, mutational, self-renewal- and quiescence-related heterogeneity. This, in addition to intrinsic and extrinsic chemoresistance, could hamper acute myeloid leukemia (AML) treatment efficacy. The efflux pumps expressed on LSC surface and LSC quiescence determine their intrinsic drug resistance. Moreover, the AML-bone marrow (BM) niche represents a LSC cradle which supports AML cell expansion and survival providing chemoprotection. On the other hand, LSC exhibit unique metabolism and altered molecular pathways offering selective therapeutic targets. LSC, leukemic stem cells; BM, bone marrow; MSC, mesenchymal stromal cells; Tregs, regulatory T-cells; AML, acute myeloid leukemia; ROS, reactive oxygen species; OXPHOS, oxidative phosphorylation; AA, amino acids.