• Omar Al Ustwani, Elizabeth A Griffiths, Eunice S Wang, and Meir Wetzler.
• Roswell Park Cancer Institute, Department of Medicine, Leukemia Section , Elm and Carlton Street, Buffalo, NY 14263 , USA +001 716 845 8447 ; +001 716 845 2343 ; Meir.Wetzler@RoswellPark.org.
• Expert Opin Pharmacother. 2014 Nov 1; 15 (16): 2397-405.

IntroductionHomoharringtonine (HHT) and other alkaloid esters were originally isolated from the Cephalotaxus evergreen tree and have been used in traditional Chinese medicine since the 1970s to treat a variety of malignancies. Although HHT was investigated for the treatment of chronic myeloid leukemia (CML) in the 1990s with good results, the advent of BCR-ABL1 tyrosine kinase inhibitors (TKIs) at that time rapidly established a new standard of care for CML. Omacetaxine mepesuccinate is a semisynthetic derivative of HHT with known clinical activity in relapsed or refractory CML following TKI therapy.Areas CoveredIn this review, we summarize the biologic effects of HHT and its derivative, omacetaxine, in CML. Additionally, we analyze the concepts learned from the early trials using these drugs. Data from clinical trials resulting in drug approval are also reviewed.Expert OpinionOmacetaxine has a clear role in the CML armamentarium for patients in chronic and accelerated phase who have failed or were intolerant to two or more TKIs.

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