CAR T-cell therapy for AML ideally targets LSCs and AML blasts, but spares HSCs
and myelopoiesis. Early approaches such as targeting of CD123 (a) and CD33 (b)
did not spare HSCs or myelopoiesis, resulting in aplasia. (c) More complex
targeting approaches where CAR T activation is triggered only by the presence of
2 antigens can allow increased specificity. In this example, CD13 is expressed
by LSC and blasts, but it is also expressed by HSCs and myeloid cells. Although
TIM3 is expressed outside the hematopoietic system, it is expressed on AML cells
but not on normal HSCs. (d) Finally, some antigens such as Siglec-6, which are
expressed on AML cells but not on normal hematopoietic cells may allow simple
and selective targeting of AML.