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Acute Myeloid Leukemia (AML), a malignant hematologic neoplasm marked by abnormal proliferation and infiltration of myeloid precursor cells into the bone marrow, exhibits the highest fatality rate. Homoharringtonine continues to demonstrate efficacy and dependability in the clinical management of AML. We have, herein, summarized a series of problems associated with HHT in the treatment of AML, including the mechanism of action of HHT combined with other drugs, drug resistance mechanisms, and action targets. With the emergence of drug resistance and disease recurrence, combination therapies have become a more effective clinical drug choice. Based on previous studies, we propose that β-catenin and GSK-3β may play a decisive role in p-eIf4E-mediated multidrug resistance. It is necessary to investigate whether HHT can bind to MCL-1 and downregulate its expression to overcome venetoclax’s resistance. Currently, there is an ongoing effort to conduct further mechanistic investigations into the combined use of HHT and other pharmaceuticals, aimed at enhancing therapeutic outcomes and addressing drug resistance in patients diagnosed with refractory AML.
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