Although many cancer patients fear relapse, Marell Tomeh, a former undergraduate student at UTM, never thought that her cancer would return. Diagnosed in 2013 at the age of 19 with Acute Lymphoblastic Leukemia, Tomeh dropped out of university to undergo 2.5 years of treatment. In September 2018, Tomeh relapsed and had to leave school again. This time, Tomeh needs a stem cell transplant. In the entire worldwide registry, consisting of willing donors ranging from family members to strangers, Tomeh currently does not have a match.

Tomeh’s story has recently inspired a social media movement spanning across Facebook and Instagram, with notable media personalities like TSN’s Cabbie Richards and CP24’s news anchor Amber Paiye encouraging people between the ages of 17 and 35 to get tested to see if they can be a stem cell donor not only for Tomeh, but for anyone on the registry.

To discuss stem cells, their uses in the medical field, and their connection with Leukemia, The Medium contacted Dr. Ho-Sung Rhee, an assistant professor in UTM’s biology department, and Dr. Ted Erclik, an assistant professor in U of T’s department of cell and systems biology.

According to Rhee, stem cells “have the ability to be differentiated into any cell types.” They can become specialized cells with specific functions, including blood cells and brain cells. For those who require a stem cell transplant, Rhee explains that the transplant will replace damaged or destroyed stem cells with healthy stem cells.

Regarding the connection between stem cells and leukemia, Rhee explains that leukemia is “a kind of cancer that begins in the bone marrow, where blood stem cells are made.” Since patients diagnosed with Leukemia fail to produce normal blood cells, a stem cell transplant will place new stem cells in their bone marrow. This process is integral to the creation of healthy blood cells.

Erclik also emphasizes the importance of stem cells. He notes that stem cells are capable of self-renewing and self-generating, and their ability to potentially become any cell type (known as “pluripotent stem cells”) makes them extremely powerful in the medical field.

Despite their significant use, Erclik explains that the problem with using pluripotent stem cells to assist in disease is that they only exist within us when we are very young. By the time someone may need these cells to address issues, the cells no longer exist. One way to combat this issue is to take stem cells from discarded embryos from in vitro fertilization, however since these stem cells don’t originate from the person that needs them, there is a risk of rejection by the immune system.

In the future, researchers “hope to take the patient’s own cells, revert them back into stem cell, then turn them back into whatever cell type needs to be replaced, such as blood cells, and then treat the patient with their own stem cells,” Erclik explains. “We’re close, but we aren’t there yet as a field.”

So what does this mean for Marell Tomeh? Stem cell donation is vital to her treatment and recovery. Tomeh agreed to speak with The Medium about her cancer diagnosis, her experience with relapsing, and the importance of stem cell donation.

As an active and social nineteen-year-old studying for her final exams, Tomeh was not expecting a cancer diagnosis. The initial diagnosis affected Tomeh socially, mentally, and emotionally. She had to quit her job, drop out of university, and soon began deactivating her social media accounts, focusing solely on close friends and family.

“My position at work made me feel important and respected, and going to school makes you feel like you’re accomplishing something for your future. To lose all of that can take a toll on you mentally,” Tomeh reflects. “The changes my body was going through from steroids and chemo made me develop social anxiety, which I had never dealt with before and was ashamed to admit for a long time. My life became centered around just being with those who I was absolutely comfortable with, and getting through treatment.”

Tomeh’s first treatment, the Dana Farber protocol, involved three phrases. First, the “induction phase,” intended to induce a remission. Tomeh underwent one month of intense IV chemotherapy, as well as intramuscular chemo, oral chemo, oral mediation, and Intrathecal chemo to target any leukemia cells that were hiding in her spine. The second phase consisted of brain radiation and addition chemo treatments. The final stage, “maintenance therapy,” decreased the amount of chemotherapies and steroids used. During Tomeh’s first treatment, the doctors’ aimed to have her “bone marrow produce its own healthy blood.”

Now, dealing with the relapse, Tomeh is undergoing a different treatment. Doctors introduced her to a new drug therapy called “blinatumomab” to again, induce a remission. Tomeh notes that her body is not reacting well to the extremely powerful drug. Once Tomeh completes drug therapy, the remaining treatment includes chemotherapy and full body radiation to prepare her body to accept any potential stem cell transplant.

“I was only in remission for three years, and considering that I wasn’t able to hit the five years of survivorship, getting a stem cell transplant is so important,” Tomeh emphasizes. “I learned a lot the first time around, and I always felt blessed to have learned what I did. This time around, I don’t know what’s in store for me, I don’t know if I’ll find a full match or if my body will accept the donor I do receive, but I’m hopeful.”

After Tomeh’s finished treatment the first time in July 2015, she returned back to UTM, reconnected with old friends, made new ones, and finished her first year back proud of her accomplishments. Although her oncologist suggested that Tomeh avoid holding a job while attending school, Tomeh applied at the UTM bookstore in her second year because of their flexible hours.

For Tomeh, adjusting back into a “normal” routine took a few years, but she admits that “finding your place socially after treatment as a young adult” was one of the hardest parts of integrating herself back into a regular lifestyle.

“Having been in treatment from 19 to 21 I felt like I had missed some prime years of my youth. I then went into this phase where I tried to catch up on some lost years of my youth that I thought would fill this void that I had and I soon realized that wasn’t me. It was just this year that I feel like I finally settled into myself, I realized my place was at home with my family, with the selected close friends that I enjoy spending time with, at school learning and bettering my future, going to work to make some money,” Tomeh says. “I think your priorities change after treatment, and you realize what matters and what doesn’t, what and who you want to invest your time with.”

In 2016, Tomeh publicized her experience with cancer for the first time at the University of Toronto’s Relay for Life event. That moment inspired Tomeh’s interest in public speaking and she later became an active speaker for the Terry Fox Foundation. Overwhelmed by the people connecting with her story, Tomeh decided to focus her speeches on highlighting issues around mental health and emphasizing the idea that “mental health is just as important as physical health.”

During her first diagnosis, Tomeh kept her cancer private and battled with depression and social anxiety. But this time, her family and friends encouraged her to share her story on social media to help find a potential donor. Their posts have been shared widely among the community and have convinced many people to get tested. Grateful for her family and close friends who dedicate time from their busy schedules to share her story on social media, Tomeh wants to thank strangers too.

“I’ve been so overwhelmed with how many people, especially strangers, who are willing to help. I don’t know how to personally thank every single one of them and let them know I appreciate their support,” Tomeh says.

According to The Canadian Blood Service website, stem cell transplants can treat over 80 diseases and disorders. In order to be tested as a match, individuals simply need to take a saliva swab, a kit that can be picked up at a Canadian blood clinic or ordered online through the Canadian Blood Services site. One swab is the first step in helping to save someone’s life.

Reflecting on the importance of stem cell donation, Tomeh states, “I don’t think people understand how many types of cancers and other diseases rely on stem cells for survival or rehabilitation. I need stem cells because I’ve relapsed. I wouldn’t have known any of this had I not been diagnosed with cancer. I also wouldn’t know how difficult it is for someone to find a stem cell match until I couldn’t. I think we take our health for granted a lot, and we don’t realize how fast it can change.”

“When I was healthy, before my first diagnosis, I only knew about blood and organ donation. But who thinks about stem cells? I think if people were just more aware of the process of both donating and testing, and the benefit they could be providing to so many people, it would make all the difference. It really is in you to give, and you make more of it, but for people like me who don’t make healthy stem cells, we live on the generosity of those who can.”

Tomeh’s family and friends have organized an event “Match for Marell” on November 10. Open to the public, the event will provide participants with swab kits, and will include a bake sale, raffles, food, and prizes to raise funds for Tomeh’s treatment and for stem cell awareness.

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