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Here, we analyzed the tumor immune environment in pediatric B cell precursor acute lymphoblastic leukemia by analyzing serial bone marrow samples from nine patients with primary and recurrent disease by mass cytometry using 39 immunophenotype markers, and transcriptome analysis. High\u2010dimensional single\u2010cell mass cytometry analysis elucidated a dynamic shift of T cells from na\u00efve to effector subsets, and clarified that, during relapse, the tumor immune environment comprised a T helper 1\u2010polarized immune profile, together with an increased number of effector regulatory T cells. These results were confirmed in a validation cohort using conventional flow cytometry. Furthermore, RNA transcriptome analysis identified the upregulation of immune\u2010related pathways in B cell precursor acute lymphoblastic leukemia cells during relapse, suggesting interaction with the surrounding environment. In conclusion, a tumor immune environment characterized by a T helper 1\u2010polarized immune profile, with an increased number of effector regulatory T cells, could contribute to the pathophysiology of recurrent B cell precursor acute lymphoblastic leukemia. This information could contribute to the development of effective immunotherapeutic approaches against B cell precursor acute lymphoblastic leukemia relapse.<\/jats:p>","DOI":"10.1111\/cas.15186","type":"journal-article","created":{"date-parts":[[2021,10,30]],"date-time":"2021-10-30T13:11:09Z","timestamp":1635599469000},"page":"41-52","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Alteration of the immune environment in bone marrow from children with recurrent B cell precursor acute lymphoblastic leukemia"],"prefix":"10.1111","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1846-4500","authenticated-orcid":false,"given":"Takashi","family":"Mikami","sequence":"first","affiliation":[{"name":"Department of Pediatrics Graduate School of Medicine Kyoto University Kyoto 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