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Myeloma Today: Please tell us a little about your background.

Dr. Hungria: I grew up in Itapetininga, Brazil, and obtained my M.D. degree at Santa Casa Medical School in São Paulo, where I also did my residency. At that time, I was very interested in hematology and decided to continue my training in hematology for two more years. I obtained my Master?s Degree at the University of São Paulo, when I began studying lipid metabolism in multiple myeloma. Currently, I am Professor of Hematology at Santa Casa Medical School in São Paulo.

MT: When and how did you become interested in myeloma?

Dr. Hungria: From the very beginning of my training, multiple myeloma patients caught my attention. I used to think: plasma cells are so beautiful, yet are capable of causing so much damage. The clinical damage the disease caused left me in awe. My first studies on myeloma were done with a nephrologist, as I was trying to better understand the renal damage these individuals presented.

MT: What is the standard treatment given for myeloma in Brazil?

Dr. Hungria: In large centers, high doses of chemotherapy are opted for. Those who cannot have transplants are treated with melphalan and prednisone.

MT: What tests and treatments are available?

Dr. Hungria: All the tests for diagnosis and the principal tests for the evaluation of the prognosis for patients are available in the major centers. All treatments are currently available. Patients with myeloma can receive bisphosphonates (zolendronate has been available to us since January 2001). The majority of the government-funded centers authorized to do transplants have programs for myeloma, the limitations being the number of beds available and the government-established cut off age of 65. Some Health Plans also fund transplants, without a maximum age.

MT: Are chemicals and/or viruses considered to be causes of myeloma in Brazil?

Dr. Hungria: Although described in some locations in relation to multiple myeloma, toxic substances and viruses have not yet been demonstrated to be related to multiple myeloma in Brazilian literature.

MT: In Brazil, are there differences in incidence of myeloma between ethnic groups?

Dr. Hungria: At our Hospital, we have observed 309 patients over the last 15 years and noticed some differences from literature statistics. We have treated more women than men and almost all were white.

MT: Do you think myeloma patients are more susceptible to other cancers?

Dr. Hungria: In our experience, the frequency of other tumors in myeloma patients is no different from that of the general population. Even though this disease predominantly affects older patients, we have not observed synchronic neoplasias in the same.

MT: What is your experience with thalidomide in myeloma?

Dr. Hungria: We have used thalidomide for myeloma since 1999, initially for refractory patients, and have obtained surprising results, considering that these were patients without treatment perspective. Currently, some patients receive thalidomide as post-transplant maintenance. Older patients unable to receive transplants are already receiving thalidomide and dexametasone as the first treatment.

MT: What new treatments do you see as the most promising?

Dr. Hungria: I firmly believe in antiangiogenic drugs.

MT: In Brazil, will it be possible to do genetic research using gene array technology?

Dr. Hungria: It is well-known that Brazil has been developing rapidly in the genetic field, particularly in the genome project, as its recent publications have shown.

MT: How can the IMF best help myeloma patients in Brazil?

Dr. Hungria: The IMF could help them with information and education as well as seminars for both patients and physicians.

MT: What myeloma research is currently going on in Brazil?

Dr. Hungria: At the moment, I am interested in studying the epidemiology of myeloma in Brazil and in Latin America.


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