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

Abstract

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.

The potential benefits and risks of sex-steroids therapy in thalassemic patients with hypogonadism

“…Current HBsAg positivity in thalassemia major ranges from <1% to >20% and Hepatitis B infection remains a significant cause of chronic liver disease and hepatocellular carcinoma in BTM. (•••) (75) Anti-HCV positive was present in 87% of thalassemic patients based on an Italian registry, 39.6%-74.4% in two Greek studies, and 18%-70% in studies from the Middle East (•••) (76).…”