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  • Introduction: Bladder cancer is the ninth most prevalent cancer of all cancers worldwide. Platinum based chemotherapy is the most common therapy for MIBC but nephrotoxicity is the one its side effects that still in our concern. Meanwhile metformin is widely used for antidiabetic drug, a high quality level of evidence meta analysis show that it can improve the prognosis of bladder cancer patient. Conditioned medium mesenchymal stem cells (CM-hADMSC) are known to have ability for homing to cancer cells and secrete various cytokines and chemokines which affect the apoptosis and proliferation of cancer cells. Therefore, CM-hADMSC combined with cisplatin and metformin could offer an alternative therapy for bladder cancer to reduce the side effect of cisplatin and improve the prognosis. Aim: To determine the effect of conditioned medium human Adipose Derived Mesenchymal Stem Cells (CM-hADMSC) combined with cisplatin and metformin on apoptosis and proliferation of bladder cancer cells. Material and Methods: Low-grade urothelial cancer type 5637 bladder cancer cell is exposed with cisplatin, metformin and CM-hADMSC. Flowcytometry tests were carried out using the Flowcytometry Acquisition cell sorting (FACS) Calibur to measure apoptosis. The viability and proliferation of bladder cancer cells is measured using MTT assay Results: There was a significant difference in the percentage of late apoptosis in the group receiving CM-hADMSC combined with metformin and cisplatin compared with control. The difference of bladder cancer cell viability and proliferation in the group receiving CM-hADMSC combined with metformin and cisplatin is statistically significant when compared with control group Conclusion: CM-hADMSC combined with metformin with and without cisplatin caused an increased in apoptosis and decreased proliferation in bladder carcinoma cells