Dr. Angelina Rodrigues-Morales and Dr. Amara Nouel
Myeloma Today: Please tell us a little about your backgrounds.
Dr. Rodríguez-Morales: I received my M.D. degree from Univ. Central de Venezuela in 1965, followed by internal medicine postgraduate work at Hospital Vargas, Univ. Central de Venezuela, 1966 –1968, and hematology postgraduate work at Banco de Sangre del Distrito Federal, Univ. Central de Venezuela, 1969-1970. Honorary register in Hemato-Oncology, Royal Marsden Hospital, London, 1978-1979. Currently I am Head of out-patients Hemato-Oncology Clinic, Banco de Sangre del Dto Federal and Head of Hemato-Oncology Department out-patients (Banco de Sangre Dto Federal) and in-patients (Hospital Vargas de Caracas).
I am a member and former President of the Venezuelan Hematology Society, Venezuelan Delegate to International Society of Hema-tology, member of International Society of Hematology, Venezuelan Internal Medicine Society, BADAN, Blood Bank Foundation, and Medical Society, Hospital Centro Médico de Caracas. I also teach and conduct clinical research.
Dr. Nouel: I received my M.D. degree from Universidad de Oriente in 1971, followed by a degree in hematology from the British Post-graduate Medical Federation, Honorary Registrar in Hematology Department at Addenbrooke’s Hospital, Cambridge 1973-1974, St. Georges Hospital, London 1974-1976, and a year at Royal Marsden, London, in 1995. Currently I am an Associate Professor in Hematology, Medicine School, Univ. de Oriente; Chief Director of Hematology Department, Hospital Ruiz y Paez; member of National Antineoplastic Drug Foundation (BADAN), member and former Vice President of the Venezuelan Hematology Society, member of Int’l Society of Hematology and of Latin American Cooperative Group of
Hemostasia and Thrombosis (CLATH).
MT: When and how did you become interested in myeloma?
Dr. Rodríguez-Morales: I became interested in MM about 8 years ago when we started receiving more patients with the disease.
Dr. Nouel: As soon I started my practice as
Hematologist, I was in charge of several projects to investigate the incidence, epidemiology and clinical presentation of MM patients at our hospital. This resulted in
better understanding of the pathology, early diagnosis and less morbidity for our patients.
MT: What is the standard treatment for multiple myeloma in Venezuela?
Dr. Rodríguez-Morales: We use standard treatment with melphalan (4 days) plus Prednisone (7 days) for about one year if patient responds, otherwise we change to VAD or other alternative treatment. If an auto transplant is planned, VAD is used as front line treatment. Epo is used if a renal failure with anemia is present. In addition, Aredia is used in patients with bone disease. Local radiotherapy, growth factors, plasmapheresis, and dialysis are used if indicated.
Dr. Nouel: Due to the low economic status of most of our patients, more than 90% are treated with M.P. as frontline treatment. The few that can afford a transplant are initiated on VAD. Aredia is used in most of my patients, thanks to financial help from local government or by BADAN.
MT: What are the current activities regarding myeloma in Venezuela?
Dr. Rodríguez-Morales: We are doing diagnosis, treatment and clinical follow-up in MM patients and our team just started to keep plasma samples for coagulation and thrombosis studies. At our institution, we might develop some experimental treatment if we receive some financial support from abroad.
MT: Do finances present a problem?
Dr. Rodríguez-Morales: Our Institution depends on government financing so the budget is too tight to give the best to our patients; nevertheless, clinical control, hematology, coagulation tests, proteins electrophoresis, immunoglobulins, Bence Jones proteins, immuno-electrophoresis, beta2 microglobulin, C reactive protein, biochemical tests, urine studies, bone survey, immunophenotyping are done for some patients free of charge, supported in part by our Foundation: Fundasangre. Government hospitals not supported by Social Security have severe economical problems and send their cases to our Center. Cytogenetic study of bone marrow has just become available, MRI is done but there is no plasma cells labeling index and no experience with transplants in MM in Venezuela. The program is slow because of economic problems.
Dr. Nouel: At this time, research activities outside clinical work aren’t done in Venezuela and support in this area would be very helpful.
Finances are a big problem. Experience with transplants is very limited.
MT: Is thalidomide being used to treat MM?
Dr. Rodríguez-Morales: We use thalidomide in patients refractory to front line therapy but our experience is limited because it has been available to us only since last year.
MT: How can the IMF help with problems you face with myeloma in Venezuela?
Dr. Nouel: One way to help would be to support a thorough diagnosis and follow up. Our patients could represent an interesting arm of comparison for incidence, epidemiology, clinical behavior, MP treatment and cause of death parameters. Also, more IMF informational materials available in Spanish would help patients understand the disease better and foster meetings among them.
MT: Should the IMF plan a patient seminar in Venezuela?
Dr. Rodríguez-Morales: Seminars for both patients and doctors would be helpful. Caracas is the best location because it is in the middle of the country.
MT: What do you see as the major areas of research requiring funding?
Dr. Rodríguez-Morales: Several areas are important to develop, such as coagulation aspects, molecular biology, autologous transplant, new drugs, etc.
Dr. Nouel: Apart from studies of epimediology and clinical aspects of MM, currently there is no myeloma research going on in Venezuela. Areas of research would depend on available funding. Epidemiological studies, clinical and chromosomal findings, refractory disease and thalidomide could be easiest topics to begin with.
MT: Is it possible to have a registry for myeloma patients in Venezuela to monitor incidence and causal factors?
Dr. Rodríguez-Morales: It is necessary to establish a registry of myeloma patients as there is no data available on the incidence of myeloma in Venezuela. Our group is particulary interested in obtaining more information about causal factors since Venezuela is an oil producing country, and some patients are in contact with oil derivates, pesticides or other toxics.
Dr. Nouel: In Venezuela, there is no reliable registry for myeloma patients. Local studies at some hematological centers only tell us about the incidence of myeloma in certain areas of the country. It would be important to investigate possible causal
factors affecting myeloma incidence as, for example, the preliminary results of our studies reveal that 53% of myeloma patients have some kind of relation to industrial or agricultural toxic derivatives. I am trying to improve the registry by offering to my
colleagues working in the southern part of Venezuela the use of facilities for doing diagnostics test for their patients.
MT: How can the IMF help you care for myeloma patients in Venezuela?
Dr. Rodríguez-Morales: It would be a wonderful occasion if IMF comes to Venezuela with an educational program for both patients and doctors, encourages Venezuelan doctors to participate in research projects sponsored by IFM, and supports young doctors to attend myeloma meetings as the IMF has been doing already.
Dr. Nouel: An IMF seminar would raise awareness of all the tremendous work the IMF does to help patients and encourage investigation and research of myeloma.