Incidence of Hepatocellular Carcinoma in Patients with Thalassemia Who Had Hepatitis C

  • Shahla Ansari Mail Department of Hematology & Oncnlogy, Ali Asghar Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Azita Azarkivan Department of Thalassemia Clinic, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
  • Farideh Halagi Department of Radiology, Ali Asghar Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Chelating agents, Cirrhosis, Hepatocellular carcinoma, Hepatitis C virus, Hepatitis B virus, Iron overload, Thalassemia


Hepatitis is the infections of a common cause disease among poly transfused patients. Hepatitis C is slowed progression and inducing HCC. This study assessed HCC incidences, the role of iron and possible antitumor activity of chelators in 170 thalassemia patients using deferoxamine (DFO) therapy. They are diagnosed with Hepatitis C due to positive PCR-RNA. They are Treated with IFN. The follow up program including tests every 3 Months and PCR-RNA, AFP and liver US every 6 months. Whenever there was suspicion of liver malignancy, Biopsy was performed. From the total of 170 patients,  59.4% were male, and 40.6% were female. Mean age of thalassemia diagnosis was 2.69±5.403 (1-41) years and mean Age of hepatitis diagnosis was 17.37±7.263 (3-51) years. 92.4 % of Patient's MT, 0.6 % SS, 2.9% TI. the viral genome was 1a3a. 73.5% of patients had first course of therapy. The frequency of AFP greater than 10 was 5.9%. And the incidence of HCC was 0.6 %(1/170) with a 95% confidence interval. The main risk factor for HCC was HCV infection in TM patients, but it was iron activity in TI patients. Iron chelation with DFO appeared to play a Protective role.


Emanuele Angelucci, Federica Pilo .Treatment of hepatitis C in patients with thalassemia. Haematol 2008;93(8):1121-3.

Castellino S, Lensing S, Riely C, Rai SN, Davila R, Hayden RT, Fleckenstein J, Levstik M, Taylor S, Dean PJ, Kippenbrock S, Pope J,Carr J, Strickland DK, HudsonMM. The epidemiology of chronic hepatitis C infection in survivors of childhood cancer: an update of the St Jude Children's Research Hospital hepatitis C seropositive cohort. Blood 2004;103(7):2460-6.

Hayashi K, Kumada T, Nakano S, Takeda I, Kiriyama S, Sone Y, Toyoda H, Shimizu H, Honda T.Inciden ce of hepatocellular carcinoma in chronic hepatitis C after interferon therapy. Hepato-Gasteroentrol 2002;49(4):508-12.

Di Marco V, Lo Iacono O, Almasio P, Ciaccio C, Capra M, Rizzo M, Malizia R, Maggio A, Fabiano C, Barbaria F, Craxì A. Long-Term Efficacy of α-Interferon in β- Thalassemics With Chronic Hepatitis C. Blood 1997;90(6):2207-12.

Lackner H, Moser A, Deutsch J, Kessler HH, Benesch M, Kerbl R, Schwinger W, Dornbusch HJ, Preisegger KH, Urban C. Interferon-alpha and Ribavirin in treating children and young adults with Chronic Hepatitis C after malignancy. Pediatrics 2000;106(4):E53.

Gebo KA, Bass EB. Liver Biopsy and Screening for Cancer in Hepatitis C. Am Fam Physic 2003;168(9):1719-28.

Fabberi E,Guerrini G, Pignattithe C. Risk ofhepatocellular carcinoma in patients with talassemia. A review. Acta Pediatrica Mediterranea 2009;25:47.

Moriya K, Fujie H, Shintani Y, Yotsuyanagi H, Tsutsumi T, Ishibashi K, Matsuura Y, Kimura S, Miyamura T, Koike K. The core protein of hepatitis Cvirus induces hepatocellular carcinoma in transgenic mice. Nature Med 1998;4(9):1065-7.

Puoti C, Bellis L, Martellino F, Durola L, Spilabotti L, Dell'Unto O, Galossi A, Guarisco R. Occurrence of hepatocellular carcinoma in an apparently 'healthy' HCV patient. Europ J Gastro Hepatol 2005;17(11):1263-4.

Furutani T, Hino K, Okuda M, Gondo T, Nishina S, Kitase A, Korenaga M, Xiao SY, Weinman SA, Lemon SM, Sakaida I, Okita K. Hepatic iron overload induces hepatocellular carcinoma in transgenic mice expressing the hepatitis C virus polyprotein. Gastro Enterolog 2006;130(7):2087-98.

Jensen PD, Jensen FT, Christensen T, Nielsen JL, Ellegaard J. Relationship between hepatocellular injury and transfusion iron overload prior to and during iron chelation with Desferroxamine: a study in adult patients with acquired anemia. Blood 2003;101(1):91-6.

Fragatou S, Tsourveloudis I, Manesis G. Incidence of Hepatocellular Carcinoma in a Thalassemia Unit. Hemoglobin 2010;34(3):221-6.

Mancuso A, Sciarrino E, Renda MC, Maggio A. A prospective study of hepatocellular carcinoma incidence in thalassemia. Hemoglobin 2006;30(1):119-24.

Azienda Ospedaliera V. Cervello Interferon and Ribavirin Treatment in Patients With Hemoglobinopathies. Clinical Trials Gov 2009;2(1):21-2.

How to Cite
Ansari S, Azarkivan A, Halagi F. Incidence of Hepatocellular Carcinoma in Patients with Thalassemia Who Had Hepatitis C. Acta Med Iran. 51(6):404-407.