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August 13, 2003

Long-term Use of Hydroxyurea for Sickle Cell Anemia

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(6):752. doi:10.1001/jama.290.6.752-a

To the Editor: In their observational study, Dr Steinberg and colleagues1 concluded that hydroxyurea is associated with a lower risk of myelodysplasia and acute leukemia among patients with sickle cell anemia (SCA) than among those with myeloproliferative diseases.

I am concerned, however, that the authors did not follow up the patients for long enough to detect such adverse effects of hydroxyurea. Although the mean follow-up was 7.6 years, most of the patients received hydroxyurea for less than 37 months. Furthermore, only 94 patients received it for 5 or more years. By contrast, Najean and Rain2 found that among elderly individuals with polycythemia vera, the risk of acute leukemia was not significantly increased until after 8 years of continuous use of hydroxyurea. In the study of Steinberg et al, only 23 patients received hydroxyurea for at least 8 years.

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