Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Steinberg and colleagues1 did not find any increase in opportunistic infections
in patients with SCA who received hydroxyurea therapy. Indeed, the risk of
such infections is apparently low.2
We recently reported a case of a patient who developed a chronic opportunistic
infection associated with hydroxyurea therapy.3 This
was associated with abnormalities in T-lymphocytes, including a low CD4 cell
count and low CD4:CD8 ratio. Both the infection and these abnormalities resolved
after discontinuation of hydroxyurea. We believe that this observation is
consistent with the possibility that this drug, like other antimetabolites,
may suppress T-lymphocyte counts. While Steinberg et al did monitor neutrophil,
red blood cell, and platelet counts, they did not examine lymphocyte parameters.
We believe that future studies involving the use of this drug, especially
in patients with less-severe SCA, should include a formal assessment of its
affect on lymphocyte counts.
Feldman L, Allen S, Westerman M, Feldman L, Gilman-Sachs A, Beaman K. Long-term Use of Hydroxyurea for Sickle Cell AnemiaLong-term Use of Hydroxyurea for Sickle Cell Anemia. JAMA. 2003;290(6):752. doi:10.1001/jama.290.6.752-a