Table 2.

Key milestones in HHT’s clinical development: a chronological overview

Years	Milestone	Description	Significance	References
2006	Initial Discovery and Preclinical Studies	Identification of HHT’s cytotoxic properties against lymphoid and myeloid cells	Foundation for the clinical potential of HHT	[52]
2007	Confirmation of Apoptotic Efficacy	HHT shown effective in various tumors, including primary leukemic cells from AML patients	Broadened therapeutic scope of HHT	[54]
2011	Regulatory Approval of Omacetaxine (OM)	OM, a semi-synthetic HHT derivative, approved by EMA and FDA for CML treatment	Marked HHT's entry into clinical use for CML	[53]
2011–2016	Advanced Efficacy Studies	Studies highlighted OM’s mechanism in rapid protein degradation and the up-regulation of myosin-9	Reinforced HHT’s effectiveness in hematologic malignancies	[55, 56]
2014	Elucidation of Mechanism of Action	Detailed understanding of how HHT and OM inhibit protein translation in cancer cells	Clarified the molecular basis of HHT's anticancer action	[53]

AML: Acute Myeloid Leukemia; CML: Chronic Myeloid Leukemia; EMA: European Medicines Agency; FDA: Food and Drug Administration; HHT: Homoharringtonine; OM: Omacetaxine Mepesuccinate