Does haemophilia influence cancer-related mortality in HIV-negative patients?

Abstract

Clinical investigations and animal studies suggest haemophilia specific effects on cancer-related mortality aside from virus induced malignancies. Analysis of results in the literature proposes that coagulation factor deficiency might inhibit cancer metastasis through decreased activation of thrombin. On the other hand, substitution of coagulation factor might increase cancer rates. A review of epidemiological studies was conducted to survey the clinical data on cancer rates. Clinical investigations concerning cancer-related mortality in haemophilia always deal with virus-related malignancies caused by HIV and/or hepatitis C virus (HCV) infections. Therefore, analysis of cancer rates and standardized mortality ratios (SMR) of cancer in the literature was conducted under exclusion of HIV infection and concomitant malignancies like non-Hodgkin-lymphomas and under exclusion of HCV-related deaths caused by liver disease and hepatocellular carcinoma. The survey covers epidemiological studies which report causes of deaths of more than 8000 haemophilia patients, including more than 2700 HIV-negative patients. Results show virus independent cancer rates of 8-16% of deaths. Analysis of corresponding SMRs supports the hypothesis that cancer rates, unaffected through HIV or hepatoma, are decreased in haemophilia when compared with the general population. Prospective data collection regarding factor consumption as well as severity of haemophilia in virus negative cancer patients is needed to investigate the interaction between haemophilia and cancer.