Prevalence of malignancies among U.S. male patients with haemophilia: a review of the Haemophilia Surveillance System
ABSTRACT The prevalence of malignancies in US male patients with haemophilia, with or without concomitant viral infections, remains unknown. To estimate the prevalence of malignancy in US male patients with haemophilia. We investigated the prevalence of malignancies among male patients with haemophilia using data from a six-state haemophilia surveillance project. Case patients with malignancies were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes abstracted from hospital records and death certificates during the surveillance period. Cancer prevalence rates were calculated for each year during the surveillance and compared with age- and race-specific prevalence rates among the U.S. male population obtained from the Surveillance, Epidemiology and End Results (SEER) Program. A total of 7 cases of leukaemia, 23 cases of lymphoma and 56 classifiable solid malignancies were identified among 3510 case patients during a total of 15,330 annual data abstraction collections. The rates of leukaemia, lymphoma and liver cancer among case patients were significantly higher than the rates among U.S. males as judged by prevalence ratios of 3.1 [95% confidence interval (CI) = 1.4-7.0] and 2.9 (95% CI =1.8-4.6), respectively. In contrast, the prevalence ratio of prostate cancer was lower than expected at 0.49 (95% CI = 0.31-0.77). Overall the prevalence of most cancers among case patients was similar to that of the U.S. male population. However, patients with haemophilia who have unexplained symptoms should be evaluated for malignancy.
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ABSTRACT: Lymphomas or hepatocarcinomas related to blood-borne transmitted diseases are well-known malignancies in persons with haemophilia (PWH). However, rising life expectancy has increased the number of PWH suffering from other malignancies. This study aimed to collect cancer occurrence data in PWH followed in five European haemophilia treatment centres (Brussels, Geneva, Marseille, Montpellier and Paris-Bicêtre) over the last 10 years and to analyse some particular features of cancer occurring in PWH. In total, 45 malignancies were diagnosed in 1067 PWH. The most common malignancies were hepatocellular carcinoma (12/45) and urogenital tract tumours (9/45). Bleeding at presentation or changes in bleeding pattern was indicative of cancer in four patients. Three patients with mild haemophilia developed anti-factor VIII inhibitors after intensive substitution therapy prior to surgery or invasive procedures. There was no bleeding associated with chemotherapy or radiotherapy. A few bleeding complications occurred following invasive (3/39) or surgical procedures (2/27) as a result of insufficient hemostatic coverage or in spite of adequate substitution. No bleeding was noted after liver or prostate biopsies. Following cancer diagnosis, five patients were switched from on-demand to prolonged prophylaxis substitution. In the majority of cases, the standard cancer treatment protocol was not modified on account of concomitant haemophilia. Thus, oncological treatments are not contraindicated and should not be withheld in PWH assuming that adequate haemostasis correction is undertaken. As shown by our study results, a change in bleeding pattern in adult PWH should raise suspicion of a malignancy. Intensive substitution must be considered a risk factor for inhibitor development.Haemophilia 08/2013; 20(1). DOI:10.1111/hae.12250 · 2.47 Impact Factor
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ABSTRACT: Life expectancy for people with haemophilia (PWH) has improved and is now approaching that of the general population. The growing population of elderly PWH will therefore increasingly face the age-related morbidities such as cardiovascular diseases, malignant disease, liver disease, and bone and joint related diseases, as well as the lifestyle and psychosocial factors that accompany many of these conditions. For many PWH, frequent contact with haemophilia specialists within the comprehensive care centres supplants the relationship that individuals in the general population have with their general practitioners. As a result, there is a risk that elderly PWH may miss the chronic disease screening opportunities offered to the general population. This review focuses on the screening tests and examinations recommended for age-related comorbidities in the general population that may be applicable to the growing population of older people with haemophilia.Critical reviews in oncology/hematology 08/2013; DOI:10.1016/j.critrevonc.2013.07.005 · 4.05 Impact Factor
Article: Old Age Medicine and Hemophilia[Show abstract] [Hide abstract]
ABSTRACT: Due to an increased life expectancy, besides hemophilia-related comorbidity (e.g. arthropathy, hepatitis C and human immunodeficiency virus infection) nonhemophilia-related medical problems are seen increasingly in hemophilia patients. Treatment recommendations and psychosocial consequences in aging hemophilia patients are discussed. While hypertension is reported to occur more often in hemophilia patients than in the general population, mortality from cardiovascular disease is lower, although the incidence is increasing. Despite having a higher risk profile, the incidence of myocardial infarction is also lower, especially in severe hemophilia. General indications for cardiac intervention can be applied to hemophilia patients. Treatment of ischemic heart disease using adequate clotting factor concentrate (CFC) correction in combination with an adapted anticoagulant and antiplatelet therapeutical schedule should be tailored to the individual patient, depending on the clinical situation. Recommendations are given on dealing with tooth extraction, surgical intervention, and sexuality problems in patients with hemophilia. In addition to hemophilia in itself, comorbidity has a major psychological impact, and important effects on sexuality and quality of life. It can also result in complex treatment regimens, in which coordination among healthcare workers is essential.