I’ve been getting a lot of questions about Indianapolis Colts’ Head Coach Chuck Pagano lately, so I thought I would dedicate a blog entry to discussing his disease and prognosis.
Coach Pagano was recently diagnosed with acute myeloid leukemia (AML), a form of blood cancer that typically carries a rather grim long-term prognosis in adults. While early reports were quite sketchy on the details of Pagano’s presenting symptoms, it seems that he complained mainly of fatigue and perhaps easy bruising. Both these symptoms are common manifestations of AML, as the cancer causes declines in healthy blood counts, often leading to anemia (low red blood) and thrombocytopenia (low platelets – this leads to bruising and bleeding). Pagano was admitted to Indiana University Medical Center where he underwent additional testing and began his initial treatment.
More recent reports have actually shed some important positive light on his diagnosis. Pagano’s leukemia has been more accurately classified as acute promyelocytic leukemia (APL), a rare subtype of AML that accounts for only 5-10% of cases of the disease. There are roughly 600-800 new cases of APL diagnosed in the US every year, making this one of the more rare cancers seen in clinical practice. APL is a notoriously aggressive cancer and is generally felt to be fatal within months of diagnosis if left untreated.
Fortunately, APL is also among the more curable forms of acute leukemia seen in adult patients. Most patients diagnosed with APL are treated with induction chemotherapy, a course of therapy that begins with approximately one week of intravenous drugs administered in a hospital setting. This potent treatment obliterates the cancer, but takes with it most of the patient’s healthy bone marrow cells. Patients will then remain in the hospital for several weeks waiting for the recovery of their bone marrow cells before they can be released. During this time patients will need to stay in isolation to avoid infections, as their immunity is severely compromised from the treatment. They will also require supportive transfusions almost daily until their bone marrow resumes producing blood cells in sufficient number. Apparently Pagano is currently at this phase of his treatment.
The overwhelming majority (about 80-95%) of APL patients will achieve a complete remission (CR) with induction chemotherapy. Upon achieving CR, most patients will go on to receive additional chemotherapy (typical less intensive) known as consolidation, followed then by maintenance therapy for a prolonged duration.
Compared with other forms of AML, the survival statistics for APL are very favorable. Using this modern approach (induction, consolidation, and maintenance), rates of two-year survival range from 69 to 88%, and the likelihood of surviving 10 years ranges from 58 to 85 percent.
I am confident Coach Pagano is receiving the best possible care at Indiana University. IU is fortunate to have Dr. Larry Cripe, an expert on AML, who is currently overseeing Pagano’s care. Having trained under Dr. Cripe myself, I have seen firsthand his immense knowledge as well as his profound compassion in his daily commitment to patients with leukemia. Pagano is undoubtedly in good hands.
I would like to wish Coach Pagano and his family all the best. Hopefully he can make a speedy, uneventful recovery and return to coaching as soon as he is medically released.
John Salter is a hematologist-oncologist who blogs at SalterMD.com.