EXTRACELLULAR VESICLES IN ADULT ACUTE MYELOID LEUKEMIA

Acute Myeloid Leukemia (AML) is an aggressive hematologic malignancy marked by uncontrolled expansion of immature myeloid cells and disruption of normal hematopoiesis. Beyond genetic abnormalities, accumulating evidence demonstrates that leukemic progression is strongly shaped by intercellular communication within the bone marrow niche. Extracellular vesicles (EVs), including exosomes and microvesicles, have emerged as key mediators of this communication, transporting bioactive molecules that influence leukemic cell behavior, immune responses, and treatment sensitivity. This systematic review synthesizes current findings on EVs in adult AML, focusing on their biogenesis, molecular cargo, roles in disease pathogenesis, diagnostic and prognostic relevance, and therapeutic potential. Following PRISMA 2020 guidelines, comprehensive searches of PubMed, Scopus, and Web of Science identified studies published between January 2020 and June 2025. Eligible articles included, in vitro, in vivo, and clinical studies examining EVs in adult AML. Methodological quality was evaluated using Joanna Briggs Institute (JBI) Critical Appraisal Tools. Of 426 records screened, eight studies met inclusion criteria. AML-derived EVs were consistently enriched with oncogenic cargoes, including miR-155, miR-21, miR-19a, VEGF, and TSG101, that enhanced leukemic proliferation, angiogenesis, immune evasion, and chemoresistance. Circulating EV-associated miRNAs, particularly miR-150 and miR-155, demonstrated strong diagnostic performance (AUC > 0.85) and prognostic value for relapse. Preclinical evidence indicated that mesenchymal stem cell–derived and dendritic cell–derived EVs may function as drug delivery systems or immune-stimulating nanovaccines, supporting their development as therapeutic platforms. Overall, EVs represent central regulators of AML biology and promising biomarkers and therapeutic tools. Advancing their clinical translation will require standardized EV isolation and characterization methods, as well as validation in large, rigorously designed studies.