Homoharringtonine is one of the cephalotaxine esters derived from Cephalotaxus fortunei Hook F, which is widely distributed in southern China and used in Chinese folk medicine for malignant tumors. Its antileukemic mechanism is related to inhibiting protein synthesis at the chain initiation level and inducing differentiation of leukemia cells. Over the past ten years, systematic studies in China have included chemotaxonomic-botanical survey, isolation and purification of active principles, partial chemical synthesis, and toxicologic, pharmacologic, and clinical studies. Clinical trials in China showed it had remission effects on leukemia (such as AML, AMoL), with major cardiovascular side effects ameliorated by prolonged infusion. The US NCI examined homoharringtonine, and Warrell et al's study confirmed Chinese experience, with 25% of 28 ANLL patients (including refractory ones) achieving CR. However, other American institutions had inconsistent results. The exact position of homoharringtonine among antileukemic agents remains to be established, and cardiovascular function monitoring is necessary. Future studies should explore homoharringtonine-containing combinations, head-to-head comparisons with current regimens, and low-dose continuous infusion.