Hydroxyurea Management During Active Infection

Key Evidence Supporting Continuation

• The American Thoracic Society guidelines state that infection risk is not increased with hydroxyurea use in patients with sickle cell disease 1, 2
• Hydroxyurea therapy was not associated with an increased incidence of infection in long-term follow-up studies of patients with sickle cell disease 1, 2
• Severe neutropenia was rare in clinical trials and was not complicated by infection 2

Neutropenia Management Without Infection Risk

• Mild to moderate neutropenia occurred in approximately 47% of patients but required only dose reductions, not discontinuation 2
• When bone marrow suppression occurs, it typically resolves within 2 weeks of temporary discontinuation if needed, and therapy can be resumed at a lower dose 1, 2

Clinical Rationale

• Prolonged hydroxyurea therapy (≥5 years) reduces mortality from 51.1% to 30.4% in patients with sickle cell disease 2
• Stopping hydroxyurea increases the risk of vaso-occlusive crises, acute chest syndrome, and hospitalizations—complications that can be triggered or worsened by infection 1, 2

Specific Guidance

• The American Society of Hematology recommends not suspending hydroxyurea when initiating doxycycline or other antibiotics 3
• Hydroxyurea should be temporarily discontinued in cases of severe myelosuppression, at least 72 hours before CAR-T cell infusion, or for hyperleukocytosis management 1, 2, 3