TO THE EDITOR:

Sickle cell disease (SCD) is a debilitating disease associated with extensive morbidity and early mortality. Survival in children has improved significantly during the last 4 decades as a result of newborn screening, penicillin prophylaxis, and pneumococcal vaccination. Although studies have not shown an increased incidence of solid tumors in adults living with SCD, 2 large population studies have revealed an increased incidence of leukemia.2,3  An association between hydroxyurea exposure in SCD and leukemia is anecdotal and unproven.4-14  Allogeneic hematopoietic cell transplantation (AlloHCT) remains the most widely available cure that can be offered to patients with SCD, with the goal of not only reversing the disease but perhaps also prolonging survival. We and others have previously reported myelodysplastic syndrome (MDS) or acute myelogenous leukemia (AML) after unsuccessful AlloHCT.8,15,16  The underlying etiology of this complication is unknown. We therefore performed detailed genomic leukemic characterization...

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