AML patients have an aberrant and dysfunctional immune state, paving the way for novel
agents targeting pathways that integrate with immune signaling, function, and response. Small molecule
immunomodulatory drugs (IMiDs) represent a class of agents derived from the parent compound, thalidomide.
There are currently 3 IMiDs approved for a variety of malignancies: thalidomide, lenalidomide,
and the newest agent, pomalidomide. IMiDs lead to a multitude of immunobiologic effects such
as cytokine modulation, co-stimulation of T cells, down-regulation of co-inhibitory molecules, enhancing
natural killer cell activity, inhibition of regulatory T cells, and repairing perturbed synapse formation
on T cells. IMiDs have been extensively studied in various AML settings with promising clinical
activity. This review discusses the immunologic effects of IMiDs, the rationale for studying IMiDs in
AML, and the published and ongoing clinical trials investigating IMiD activity in AML.