Safety of Hydroxychloroquine in Patients with APL in Remission
Hydroxychloroquine (Plaquenil) can be safely used in patients with Acute Promyelocytic Leukemia (APL) in remission as there are no specific contraindications or drug interactions that would preclude its use in this population.
Background on APL Treatment and Remission
APL is a distinct subtype of acute myeloid leukemia characterized by the t(15;17) translocation, resulting in the PML-RAR fusion protein. Current treatment approaches include:
- For low/intermediate-risk APL: ATRA (all-trans retinoic acid) combined with arsenic trioxide (ATO) 1
- For high-risk APL: ATRA combined with anthracycline-based chemotherapy 2
Complete remission rates exceed 90% with these regimens, and patients who achieve molecular remission have excellent long-term outcomes 2.
Considerations for Hydroxychloroquine Use in APL Remission
Safety Profile
- No specific contraindications exist for hydroxychloroquine use in APL patients in remission
- Hydroxychloroquine is not mentioned in any APL treatment guidelines as having interactions with standard APL treatments or maintenance therapy 2
- APL treatment guidelines focus on ATRA, arsenic trioxide, and in some cases anthracyclines, with no warnings about antimalarials or hydroxychloroquine 2
Monitoring Recommendations
When prescribing hydroxychloroquine to APL patients in remission:
- Regular blood counts: Continue routine monitoring as part of APL follow-up
- Ophthalmologic monitoring: Standard hydroxychloroquine retinopathy screening applies
- QT interval monitoring: If the patient has received arsenic trioxide previously, be aware of potential cumulative QT prolongation effects, though this is unlikely to be clinically significant once in remission
Special Considerations
Timing of Hydroxychloroquine Initiation
- Ideally start hydroxychloroquine after confirmation of molecular remission
- If the patient is on maintenance therapy (which may include ATRA, 6-mercaptopurine, and methotrexate in some protocols), no significant interactions are expected 2
Long-term Monitoring
- APL can rarely relapse even after prolonged remission (cases reported after >10 years) 3
- Regular monitoring should continue as per APL guidelines, independent of hydroxychloroquine use
- No evidence suggests hydroxychloroquine affects APL remission status or relapse risk
Conclusion
Hydroxychloroquine can be safely prescribed to patients with APL in remission. There are no specific contraindications or drug interactions with standard APL treatments or maintenance therapies that would prevent its use. Standard monitoring for hydroxychloroquine side effects should be implemented alongside the routine follow-up for APL patients in remission.