Low-dose homoharringtonine and cytarabine in combination with granulocyte colony-stimulating factor for elderly patients with de novo acute myeloid leukemia

The treatment of young patient with acute myeloid leukemia (AML) has improved dramatically during the past several decades. However, management of elderly patients with AML still remains a challenge. A total of 56 elderly patients with de novo AML were treated with homoharringtonine and cytarabine in combination with granulocyte colony-stimulating factor (HCG). The overall response rate was 75% (60.7%% complete response [CR] and 14.3% partial response). Fourteen (25%) of the 56 patients showed no response. A higher CR rate was observed in patients aged <70 years, with better-risk or intermediate-risk karyotype and with NPM1 mutations. To the date of the last follow-up, the median overall survival (OS) was 12.0 +/- 1.7 months. There were significant correlations of OS with age, initial karyotype, performance status and gene mutations (NPM1, FLT-ITD and DNMT3A) at diagnosis. The early death rate was 7.1%. Hematologic toxicity was well tolerated; and severe non-hematologic toxicity was not observed.