title: Cancers in patients with hemophilia: a retrospective study from  the Italian Association of Hemophilia Centers.
abstract: BACKGROUND
  The increased life expectancy of the hemophilia population, primarily as a result of advances in factor replacement therapy, has enabled hemophiliacs to reach an older age. Consequently, age-related diseases, such as cardiovascular disorders and cancers, are being increasingly recognized in such patients. However, only few data are available on such co-morbidities, their management and impact on the primary bleeding disorders.
  
  
  OBJECTIVE
  With the aim of investigating several still unclear issues regarding cancers in hemophilia patients, we conducted, on behalf the Italian Association of Hemophilia Centers (AICE), a study on cancers among Italian hemophiliacs.
  
  
  METHODS
  Data pertaining to 122 hemophiliacs with 127 cancers between 1980 and 2010 were retrospectively collected in 21 centers of the AICE which chose to participate.
  
  
  RESULTS
  Sixty-nine percent of cancers were recorded during the decade 2001–2010. Eighty-three percent of patients were infected with hepatitis C virus (HCV) and 22% of them were also co-infected with human immunodeficiency virus (HIV). Forty-three percent of cancers were HCV-related, whereas 9%were HIV related. Virus-related cancers were more frequent and non-virus-related cancers less frequent in patients with severe hemophilia than in those with mild/moderate forms (P = 0.0004). The non-virus-related standardized mortality ratio (SMR) was 0.3. Hemorrhagic complications occurred more frequently in patients undergoing chemotherapy (14%) or radiotherapy (19%).
  
  
  CONCLUSIONS
  The results of the present study confirm that cancers have become a new challenge for physicians working in hemophilia centers and underline the need for prospective trials to better assess the epidemiology and to optimize the management of hemophiliacs with cancer.
authors.affiliation: Regional Reference Center for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Tagliaferri
authors.forename: C
authors.initials: C
authors.lastname: Di Perna
authors.forename: C
authors.initials: C
authors.lastname: Santoro
authors.forename: P
authors.initials: P
authors.lastname: Schinco
authors.forename: R
authors.initials: R
authors.lastname: Santoro
authors.forename: G
authors.initials: G
authors.lastname: Rossetti
authors.forename: A
authors.initials: A
authors.lastname: Coppola
authors.forename: M
authors.initials: M
authors.lastname: Morfini
authors.forename: Massimo
authors.initials: M
authors.lastname: Franchini
mesh_terms: D015897:Comorbidity; D015658:HIV Infections; D006467:Hemophilia A / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D006526:Hepatitis C; D006801:Humans; D007558:Italy; D009369:Neoplasms / Q000150:complications / Q000821:virology; D012189:Retrospective Studies; D013812:Therapeutics / Q000009:adverse effects