Concise Review on the Frequency, Major Risk Factors and Surveillance of Hepatocellular Carcinoma (Hcc) in Β-Thalassemias: Past, Present and Future Perspectives

Sanctis, Vincenzo De; Soliman, Ashraf T; Daar, Shahina; Alansary, Niveen; Kattamis, Antonis; Skafida, Myrto; Galati, Maria Concetta; Christou, Soteroula; Campisi, Saveria; Messina, Giuseppe; Yassin, Mohamed A; Canatan, Duran; Maio, Salvatore Di; Jaouni, Soad Al; Raiola, Giuseppe; Karimi, Mehran; Kaleva, Valeria; Kakkar, Shruti; Mariannis, Demetris; Kattamis, Christos

doi:10.4084/mjhid.2020.006

Cited by 21 publications

(19 citation statements)

References 100 publications

(157 reference statements)

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“…Furthermore, HCV infection leads to liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). 37 Until couple of years ago, the recommended therapy for HCV treatment consisted of chelation therapy along with pegylated-interferon alpha plus ribavirin, a therapy with significant side effects. 38 More recently, the use of Direct-acting Antiviral Agents (DAAs) gave a breakthrough and demonstrated to be appropriate in HCV management in patients with thalassemia disease for whom previous regimens gave restrictions.…”

Section: Discussionmentioning

confidence: 99%

A Seroprevalence of Hbv, HCV and Hiv-1 and Correlation With Molecular Markers Among Multi-Transfused Thalassemia Patients in Western India

Mishra¹,

Shah²,

Patel³

et al. 2020

Mediterr J Hematol Infect Dis

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Background: Blood transfusion is a lifesaving therapy for patients with hemoglobinopathies. However, the need of frequent transfusion carries the risk of transfusion-transmitted infections (TTIs). This study was aimed to determine the seroprevalence of Hep-B, Hep-C and HIV-1infections among the multi-transfused Beta-thalassemic patients and correlate the same with NAT testing. Methods: Total 196 patients with Beta-thalassemia were included in the study. Patients were screened for the presence of viral markers by third generation ELISA test as well as for viral DNA/RNA by NAT. Results: Among these 196 multi-transfused Beta-thalassemia patients, 32.1% were females and 67.8% were males. A total of 100 (51.1%) patients were found to be anti-HCV antibody reactive, while HCV-RNA was positive in 66 (33.7 %) of the 196 patients tested. There were 6 (3.1%) patients reactive for anti-HIV-1 antibody, while 8 (4.1%) were positive for HIV-RNA. There were only 3 (1.5%) patients that were found to be reactive for HBsAg, however 5 (2.5%) were positive for HBV-DNA. Two (1%) patients had co-infection of anti-HCV antibody and HBsAg,whereas 6 patients were found co-infected by NAT testing, in-which 3 (1.5%) were positive for HBV-DNA and HCV-RNA, 1 (0.5%) was positive for HIV-RNA and HBV-DNA, and 2 (1%) had co-infection of HIV-RNA and HCV RNA. Conclusion: Prevalence of HCV among multi-transfused Beta-thalassemia patients is significantly higher than the normal population. On the other hand, the study showed low prevalence of HBV. Therefore, a follow-up schedule and administration of booster dose of HBV vaccine is strongly recommended for thalassemia patients. To the best of our knowledge, this is the foremost work that shows prevalence of HIV, HBV and HCV in thalassemia patients using both serology and molecular markers in Western India.

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Section: Discussionmentioning

confidence: 99%

A Seroprevalence of Hbv, HCV and Hiv-1 and Correlation With Molecular Markers Among Multi-Transfused Thalassemia Patients in Western India

Mishra¹,

Shah²,

Patel³

et al. 2020

Mediterr J Hematol Infect Dis

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“…The incidence of HCC in patients with TM has been calculated as 3.5%. Data from a prospective study with 105 adults with TDT reveal a 2% incidence of HCC during a one-year observation period [16] . Furthermore, preliminary data regarding HCC survey from 1327 thalassemic patients, aged > 30 years from 13 centers, enrolled in the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescent Medicine (ICET-A), reveal a prevalence of 1.66% in TDT patients and 1.96% in non-TDT patients [17] [Table 1].…”

Section: Hcc In Tdt Epidemiologymentioning

confidence: 99%

Hepatocellular carcinoma in transfusion dependent thalassemia patients: a review from a clinical perspective

Papadopoulos¹,

Koskinas²

2021

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Survival in patients with transfusion-dependent thalassemias (TDT) has increased, and complications such as hepatocellular carcinoma (HCC) are emerging. Risk factors include viral infection, mainly hepatitis C virus (HCV), iron overload, the presence of cirrhosis, and immune dysregulation. Median survival after HCC occurrence has been estimated at 12 months, while data regarding the incidence of HCC in this population are minimal. Implementing effective hepatitis B virus (HBV)/HCV antiviral treatment and universal HBV vaccination programs is expected to decrease the risk for hepatocarcinogenesis substantially. Significant hemosiderosis and hepatic fibrosis are common in patients with TDT despite chelation therapy and have been correlated with HCC development. Thus, iron overload should be monitored with liver iron concentration and ferritin levels, and effective chelation therapy should be applied. In addition, all TDT patients, particularly those with cirrhosis, should be under surveillance every six months with abdominal ultrasound ± alpha-fetoprotein levels, as this combination seems to provide better sensitivity for early HCC detection.

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“…Beta-thalassemia patients with HCC present relevant co-morbidities: hypogonadism (55%), myocardiopathy (52%), hypothyroidism (42%), osteoporosis (31%), diabetes (31%) and chronic renal failure (4%) [79]. This needs to be taken into account when planning surgical resection.…”

Section: Mrimentioning

confidence: 99%

Hepatocellular carcinoma in adult thalassemia patients: an expert opinion based on current evidence

et al. 2020

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Beta-thalassemia represents a heterogeneous group of haemoglobin inherited disorders, among the most common genetic diseases in the world, frequent in the Mediterranean basin. As beta-thalassemia patients' survival has increased over time, previously unknown complications are observed with increasing frequency. Among them, an increased risk of hepatocellular carcinoma (HCC) has been registered. Our aim is to reduce inequalities in diagnosis and treatment and to offer patients univocal recommendations in any institution. The members of the panel-gastroenterologists, radiologists, surgeons and oncologists-were selected on the basis of their publication records and expertise. Thirteen clinical questions, derived from clinical needs, and an integration of all the committee members' suggestions, were formulated. Modified Delphi approach involving a detailed literature review and the collective judgement of experts, was applied to this work. Thirteen statements were derived from expert opinions' based on the current literature, on recently developed reviews and on technological advancements. Each statement is discussed in a short paragraph reporting the current key evidence. As this is an emerging issue, the number of papers on HCC in beta-thalassemia patients is limited and based on anecdotal cases rather than on randomized controlled studies. Therefore, the panel has discussed, step by step, the possible differences between beta-thalassemia and non beta-thalassemia patients. Despite the paucity of the literature, practical and concise statements were generated. This paper offers a practical guide organized by statements describing how to manage HCC in patients with betathalassemia.

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Concise Review on the Frequency, Major Risk Factors and Surveillance of Hepatocellular Carcinoma (Hcc) in Β-Thalassemias: Past, Present and Future Perspectives

Cited by 21 publications

References 100 publications

A Seroprevalence of Hbv, HCV and Hiv-1 and Correlation With Molecular Markers Among Multi-Transfused Thalassemia Patients in Western India

A Seroprevalence of Hbv, HCV and Hiv-1 and Correlation With Molecular Markers Among Multi-Transfused Thalassemia Patients in Western India

Hepatocellular carcinoma in transfusion dependent thalassemia patients: a review from a clinical perspective

Hepatocellular carcinoma in adult thalassemia patients: an expert opinion based on current evidence

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