Sequential homoharringtonine and interferon-α in the treatment of early chronic phase chronic myelogenous leukemia

Homoharringtonine (HHT) is a novel plant alkaloid that produced a complete hematologic remission (CHR) in 72% of patients with late chronic phase chronic myelogenous leukemia (CML). Cytogenetic (CG) remissions were noted in 31%. In this study, six courses of HHT were administered to 90 patients with early chronic phase CML (< 1 year from diagnosis). Patients then received interferon-α (IFN-α) with a target dose of 5 MU/m² daily. Results were compared with those in a prior group of patients treated with IFN-α-based therapy between 1982 and 1990. Ninety-two percent of patients achieved CHR with HHT; CG responses were observed in 60% and were major in 27%. Both CHR and CG response rates were significantly higher than those seen in historical control patients after 6 months of IFN-α therapy. After receiving HHT, patients required lower doses of IFN-α to maintain a CHR. The median dose delivered was 2.4 MU/m². This reduction in IFN-α dose was associated with a lower incidence of myalgia and gastrointestinal (GI) disturbances than that seen in patients treated at the 5 MU/m² dose. Overall, CG responses were seen in 66% of the patients who received HHT and IFN-α compared with 61% of the historical control patients. HHT is a very effective treatment of early chronic phase CML, and ongoing trials are investigating the simultaneous administration of HHT and IFN-α, as well as that of HHT and low-dose cytosine arabinoside in patients failing IFN-α therapy.