Housewife keeping high-risk myeloma at bay, thanks to promising clinical trial

Madam Nasreen Ismail (centre) with her husband Mohd Riduan Tunggal and daughter Nur Atika Mohd Riduan.
Madam Nasreen Ismail (centre) with her husband Mohd Riduan Tunggal and daughter Nur Atika Mohd Riduan.PHOTO: BERITA HARIAN

SINGAPORE - Madam Nasreen Ismail, 52, should have been battling for her life or, perhaps, even dead by now.

Instead, she is still able to go out shopping with her five grandchildren, aged between two and nine.

For that, she has a clinical trial and a new drug to thank.

Madam Nasreen was diagnosed with multiple myeloma just 10 days before her 50th birthday in March 2016.

She had the "high risk" variety that hits one in three myeloma patients and leaves them with a poor chance of survival, even with treatment.

People with high-risk myeloma generally survive two to three years. For those with standard myeloma, half would live beyond five years.

Madam Nasreen, a housewife, has not only crossed the three-year-mark; less than one in a million of her bone marrow cells is now cancerous. In other words, her cancer is in complete remission and her risk of getting a relapse is low.


In people with multiple myeloma, it is not unusual for half the bone marrow cells to be cancerous.

Dr Chandramouli Nagarajan, a haematologist at Singapore General Hospital (SGH), said no one knows what causes the cancer, which is currently incurable. Every month, more than 10 people here are diagnosed with this cancer of the bone marrow. Most are in their 60s, though it can hit people in their 40s.

Madam Nasreen's recovery was aided by two pieces of fortune. First, she was one of 30 high-risk multiple myeloma patients who were enrolled in a clinical trial here to test the effectiveness of a drug that is currently used only when a patient has been treated, and relapses.

Multiple myeloma patients are treated with a cocktail of drugs, including chemotherapy. In the trial, one of the drugs is replaced with the new one now being tested to see if this yields better results.

Singapore was one of the first places in the world to try this out. Its early success has spurred more such trials in the world.

Madam Nasreen was also lucky that she was relatively fit, which meant she was among the one-third of patients considered suitable for a transplant, which offers the best results, regardless of whether the patient has the standard or high risk version.

After the treatment to reduce the cancer, some of the cleaner cells are extracted from the bone marrow. Those that remain are killed off as the body is bombarded with even stronger drugs. The cleaner cells that had been harvested earlier are now put back.

The treatment was very painful, said Madam Nasreen. But it has given her more than a fighting chance.

She recalled that her troubles began with backache and numb fingers. It was the cancer announcing itself. Within months, the pain was so bad that she could not even get out of bed, and had to be carried to the toilet.

Once treatment started, she began to improve, although the pain was still there, and she was losing hair and appetite.

It was after the transplant that things improved. She can now do housework, go out with her grandchildren and eat, even though her appetite is not fully restored.

She wishes to go on the haj, but the treatment has eaten into her savings.

She is Singaporean but her taxi-driver husband and five children are Malaysian. Until MediShield Life, she did not have any medical insurance. Although much of her treatment is free under the trial, and she gets help from Medifund, there are still other costs.

But she is not complaining. She does not know what caused her cancer, but she is grateful that she has been given a second lease of life.

Dr Chen Yunxin, a haematologist at SGH and the principal investigator of the trial that recruited its first patient in October 2014, said half the patients have achieved complete remission - an improvement over the 30 per cent under normal treatment.

So far, the median survival for this group is 37.2 months. This figure is not final as the majority are still alive.