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Myeloma Today: Please tell our readers a little about your background.

Dr. Beksac: I was born in Izmir, Turkey. I was graduated from Hacettepe University School of Medicine (1980) where I also completed my internal medicine fellowship (1985). During my residency, I visited Karolinska Hospital Division of Hematology (1983-1984) where I was able to work with Prof. Peter Reizenstein both at the Hematology Clinic and the Lab. While I got my fist experience in autologous BMT, I also earned my knowledge of hematological laboratory techniques here. My stay was very productive with five publications in peer-reviewed journals. Later, I returned to Ankara and completed my residency. Following a short assignment for a government hospital, I started and completed my hematology fellowship in Ankara University. I was appointed Associate Professor in 1987 and am currently Professor of Hematology in Ankara University, Ibni Sina Hospital since 1993. I have visited various Hematology Clinics and Laboratories such as Dana Farber Cancer Institute, New York Medical College and Cedars-Sinai Comprehensive Cancer Center for 5 to 6 week periods during the last four years. My collaboration with Dr. James Berenson has intensified my interest in myeloma and I have focused my research on myeloma with the support I received from him and his team. I joined the Board of Scientific Advisors for the International Myeloma Foundation in 1999. I am also a member of American Society of Hematology, EORTC-LCG, EBMT and research secretary in the executive committee of Turkish Society of Hematology.

MT: When did you become interested in myeloma?

Dr. Beksac: During my Karolinska days, one of my research projects was Òa retrospective analysis of three different chemotherapy regimens on the outcome of patients with myelomaÓ which we completed and published with Dr. Eva Osby in 1985. My research was not concentrated on myeloma untill ASH 1997, when the data on HHV8 in myeloma from UCLA urged me to perform similar analysis in Turkish myeloma patients. Following this project, I have been working on different prospects of myeloma such as telomerase activity.

MT: What is the standard treatment for myeloma in Turkey?

Dr. Beksac: For patients over the age of 55 and referred to Hematology Departments, the standard approach is melphalan-prednisolone. For candidates of autologous transplantation, VAD chemotherapy is the choice. However, since transplant centers and their capacities are limited to approximately 300 transplants per a year, not all canditates can receive APBSCT. Only a few patients with HLA identical donors have received AlloBMT.

MT: Is there any mechanism in Turkey to activate experimental protocol treatments?

Dr. Beksac: Within the construction of Turkish Society of Hematology, there are 12 subcommittees. The adult hematological oncology and blood-marrow transplantation subcommittees are involved in such activities. Phase II-III clinical trials of pharmaceutical companies or international organisations such as EORTC are also conducted in compliance with GCP regulations.

MT: Are there certain tests and/or treatments that are not readily available?

Dr. Beksac: Tomography, MRI, nuclear medicine facilities are available in all major cities. PET-scanning is currently possible at 2 cities but is expected to increase in number soon. There are at least 10 active transplant centers where adult patients are being treated.

MT: Is thalidomide being used in Turkey to treat multiple myeloma?

Dr. Beksac: Thalidomide has not yet been registered for myeloma in Turkey. However we can obtain the drug thanks to a generous supply from Grunenthal after fullfilling the GCP requirements.

MT: How can the IMF help myeloma patients in Turkey?

Dr. Beksac: The IMF Patient & Family Seminar which will be held in Istanbul in June is a great opportunity for patients and families to gather and share their problems. This will be a first seminar of its kind in Turkey. Drawing public attention to myeloma may help people get informed, may increase the rate of diagnosis and may help to prevent increase of the causes (i.e. hepatitis, enviromental pollution, etc.). Finally, it will be a good opportunity for patients to improve their knowledge with the help of a distinguished international faculty.

MT: Please tell us about your myeloma research. What do you see as the major areas of research that need to be addressed?

Dr. Beksac: My recent research was on the detection of HHV8 in Turkish patients with myeloma. My results have recently been confirmed by an independent laboratory in Turkey. Due to differences in the techniques and the origin of nucleic acids, not all investigators have been able to validate our results. We believe that we are detecting an HHV8 strain. What is even more interesting is the similarity in the differences observed in Turkish patients and patients from the USA. My current research subject is the role of telomeres in myeloma. Telomeres are the repeats at the ends of chromosomes and they are the time-clocks which regulate the life span of a cell. Due to an end-replication problem, telomeres shorten after each cell division. Thus, cells with a high proliferation rate die more quickly. If this mechanism involves cancer cells they are expected to have a shorter life-span than their normal counterparts. Highly proliferating cells of dermis, mucosa and germ cells have an enzyme, telomerase, which repairs these ends. This physiological mechanism can sometimes be used by malignant cells as well. The role of telomeres and telomerase activity had not been investigated in myeloma when we started this project. We were able to observe higher activity of telomerase in plasma cells compared to nonplasma cells of same individuals. Our research is still underway. We hope anti-telomerase approaches in future may strengthen our battle against myeloma.

MT: Is it possible to have a registry in Turkey to monitor the incidence of myeloma and causal factors?

Dr. Beksac: Currently there is no official registry for myeloma patients. The coming IMF Seminar will enable us to gather more reliable data about the epidemiology of myeloma in Turkey. There are many well educated physicians and scientists here and collaboration between centers working in the same field will certainly improve our current position against myeloma worldwide.

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