Surveillance for hepatocellular carcinoma after autologous stem cell transplantation in cirrhosis.
BACKGROUND
During the resent years there has been interest in using bone marrow stem cells to treat liver cirrhosis. However, there is a potential concern for malignant transformation after stem cell therapy. The aim of this study was to evaluate the development of hepatocellular carcinoma (HCC) after autologous bone marrow stem cell transplantation for liver cirrhosis.


METHODS
All the patients who underwent autologous stem cell transplantation for liver cirrhosis between 2005 and 2011 at our center were enrolled. Cellular infusion was made through peripheral vein, portal vein, or hepatic artery.The patients were invited to undergo screening for hepatocellular carcinoma. The screening was made with ultrasonography and alpha-feto protein (AFP) measurement.


RESULTS
Thirty two patients (18 males) were included in the study. Mean age of patients was 45.7 years. Fifteen patients (47%) received mesenchymal stem cell (MSC), 9 (28%) received bone marrow mononuclear cells, 5 (16%) were given CD 133-positive bone marrow cells, and 3 (9%) patients received CD 34-positive bone marrow cells. Mean duration of follow up was 20.5months. Mean serum level of AFP was 2.8 ng/ml at baseline and 3.4ng/ml at the end of follow up (p= 0.3). One patient was found to have hepatocellular carcinoma three months after infusion of bone marrow mononuclear cells. The incidence rate for HCC was 1.8 cases per 100 person-years in this study.


CONCLUSIONS
Autologous bone marrow stem cell infusion does not appear to increase the risk of hepatocellular carcinoma. The incidence rate of HCC in this study is comparable or even less than the reported rates of HCC in cohort studies of cirrhotic patients.
Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mehdi
M
Mohamadnejad
Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mandana
M
Ashrafi
Hematology, Oncology, BMT Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Kamran
K
Alimoghaddam
Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran ; Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
Masoud
M
Vosough
Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
Soura
S
Mardpour
Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
Vajiheh
V
Azimian
Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
Nasser
N
Aghdami
Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad
M
Bagheri
Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Leila
L
Abdollahzadeh
Hematology, Oncology, BMT Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Maryam
M
Bashtar
Noor Medical Imaging Center, Tehran, Iran.
Shahram
S
Akhlaghpoor
Hematology, Oncology, BMT Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Ardeshir
A
Ghavamzadeh
Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran ; Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
Hossein
H
Baharvand
Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Reza
R
Malekzadeh
Cirrhosis; Liver; Stem cells