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Omacetaxine + decitabine is an investigational combination therapy being evaluated for the treatment of older patients with previously untreated acute myeloid leukemia (AML) and high-risk myelodysplastic syndromes (MDS). Omacetaxine mepesuccinate is a semisynthetic plant alkaloid derived from homoharringtonine that acts as a protein synthesis inhibitor by binding to the ribosomal A-site, thereby downregulating proteins involved in cell survival and proliferation, such as MCL-1. Decitabine is a hypomethylating agent that incorporates into DNA and inhibits DNA methyltransferase, leading to the reactivation of silenced tumor suppressor genes. This combination, primarily investigated by the M.D. Anderson Cancer Center, aims to synergistically target malignant stem cells and provide a lower-intensity treatment option for patients who may not tolerate standard intensive chemotherapy.
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