Homoharringtonine Shows Promising Efficacy for Patients With AML
Homoharringtonine may be added to idarubicin and cytarabine to induce remission for patients with newly diagnosed acute myeloid leukemia (AML). Homoharringtonine is associated with statistically significant improved overall survival (OS) and event-free survival (EFS), even in patients with peripheral blasts remaining after induction.
“Individualized chemotherapy, which is at the forefront of AML treatment, has moderately improved outcomes over the past decade. Monitoring the peripheral blood blast burden during induction by flow cytometry has shown significant value in the evaluation of treatment responses. Our previous study reported the day 5 peripheral blast clearance rate (D5-PBCR) as an indicator of early treatment response, and D5-PBCR (+) patients showed poor outcomes,” wrote lead author Yunxiang Zhang, MD, Shanghai Institute of Hematology, Shanghai Jiao Tong University School of Medicine, Shanghai, China, and colleagues.
The researchers examined the roles of homoharringtonine and D5-PBCR in a single-arm, phase 2 trial, which enrolled 151 patients. Of the cohort, 65 were D5-PBCR (+). Overall, 55 subjects received homoharringtonine in addition to chemotherapy. The median follow-up was 53.1 months.
The overall complete remission (CR) rate after 1 course of induction was 84.4%. For D5-PBCR (-) patients, it was 87.5%; in D5-PBCR (+) patients, it was 80%. The median EFS was 42.2 months, and did not show significant differences between the D5-PBCR (-) and D5-PBCR (+) groups. The incidence of grade 3 and 4 adverse events (AEs) was comparable between the 2 groups.
Compared to historical data, significant improvements in both OS (P = .02) and EFS (P = .02) were observed in the D5-PBCR (+) group.
