AIM: To investigate the complete remssion(CR)，overall survival(OS)，event free survival(EFS)and adverse events of newly diagnosised acute promyelocytic leukemia (APL) treated with low dose homoharringtonine(HHT), alltrans retinoic acid(ATRA) and arsenic trioxide(ATO), and to evaluate the efficacy treatment outcome by comparing HHT,ATRA and ATO with idarubicin(IDA), ATRA and ATO. METHODS: A total of 145 cases (74 in HHT group, 71 in IDA group) of newly diagnosed acute promyelocytic leukemia from January 2004 to December 2013 in The First affiliated hospital of Zhejiang University School of Medicine and Yinzhou Hospital Affiliated to Ningbo University were analyzed, and were enrolled in the analyses of clinical feature, molecular biology，OS and EFS after long term follow up．RESULTS:The overall CR of 145 pations was 97.2%(141/145), the CR rate of HTT group and IDA group was similar（98.6% vs. 95.7%，P=0.36）. The interval to achieve hematological CR in two group was 32.89 and 33.3 days，the converting to PML/RARa PCR-negative from the induction therapy was 1.9 and 2.17 months respectively, similarly, there were no significant difference between the two groups (P=0.645 and 0.091, respectively）. Four patients occurred early death (2.8%), 3 cases died of intracranial hemorrhage, 1 case died of respiratory distress (ARDS). With a median follow-up of 45.6 months, the two groups did not differ between the OS and EFS (P=0.9 and 0.093). A total of 13 patients relapse, including 5 cases of recurrence of molecular biology, the central nervous system relapse in 2 cases, there was no statistically significant difference of recurrence rates in the two groups (6.7% vs. 11.2%, P=0.342). And the risk group was not the factor affecting OS and EFS (P>0.05)．While the incidence of hematology toxicity and grade 1 fever in HTT group were significantly lower than IDA group (P=0.003 and 0.037). And no difference was found in terms of liver dysfunction，renal dysfunction，cardiac dysfunction，and visceral bleeding, etc between two groups. CONCLUSION: Our study demonstrated comparable therapeutic effect of low dose HHT or IDA on APL，HHT was also well tolerated and had lower hematology toxicity and infection rate．
