Efficacy and Safety of Homoharringtonine for the Treatment of Acute Myeloid Leukemia: A Meta-analysis

Background: To evaluate the efficacy and safety of homoharringtonine (HHT) in acute myeloid leukemia (AML).

Methods: PubMed, Cochrane Library, Embase, China National Knowledge of Infrastructure, and Wanfang data were systematically searched until October 31, 2020, for AML treatment with and without HHT. Fixed- and random-effect models were used to pool main outcomes, and between-study heterogeneity was assessed.

Results: A total of 37 articles (2846 patients) fitting our criterion were included. The pooled overall response rate for the patients treated with HHT was 82% (CI, 77.9%-85.6%; I² = 73.5%), and the complete response rate was 63.4% (CI, 58.8%-68%; I² = 67.3%). Our study showed that patients treated with HHT have more overall response and complete response benefits and less cardiotoxicity and relapse rate. Subgroup analysis showed that patients with AML treated with HHT have significant overall response benefits in patients younger than 60 (odds ratio [OR], 1.63; CI, 1.33-2; I² = 1.7%; P < .001), the newly diagnosed (OR, 1.59; CI, 1.15-2.21; I² = 34.7%; P = .006), and relapsed/refractory patients (OR, 2.13; CI, 1.38-3.29; I² = 32.3%; P = .001). Better complete remission benefits were observed in patients younger than 60 (OR, 1.32; CI, 1.1-1.59; I² = 7%; P = .004), the newly diagnosed (OR, 1.32; CI, 1.08-1.62; I² = 33.5%; P = .006), and relapsed/refractory patients (OR, 1.81; CI, 1.19-2.77; P = .006). For elderly patients, HHT treatment reduced relapse risk by 76.6% (OR, 0.23; CI, 0.09-0.63; I² = 0%; P = .004).

Conclusions: HHT can be a reliable choice with less cardiotoxicity for patients with AML, especially for the newly diagnosed or patients younger than 60. For elderly intolerant patients, the use of HHT can reduce relapse.