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August 13, 2003

Long-term Use of Hydroxyurea for Sickle Cell AnemiaLong-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: 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.