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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.

I am aware of only 3 cases of acute leukemia in patients . . . [Full Text of this Article]

Derrick W. Spell, MD
Earl K. Long Medical Center
Louisiana State University Health Sciences Center
Baton Rouge

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