Prognosis favorable for Colts coach with leukemia
Chuck Pagano's doctors say they are confident he will beat his cancer.
October 1st, 2012
07:47 PM ET

Prognosis favorable for Colts coach with leukemia

Chuck Pagano is only the second head coach in recent NFL history to be diagnosed with cancer during the season, according to Indianapolis Colts Owner Jim Irsay.

Pagano was hospitalized Wednesday night and immediately began treatment after being diagnosed with "acute promyelocytic leukemia," a subtype of acute myeloid leukemia, "which is a cancer of the bone marrow tissue," according to his physician Dr. Larry Cripe, a leukemia expert from the Indiana University School of Medicine.

Here are a few things to know about leukemia and specifically acute promyelocytic leukemia or APL:

How common is APL?
Each year, more than 40,800 adults and 3,500 children are diagnosed with all kinds of blood and bone marrow cancer called leukemia, according to the National Cancer Institute. About 13,780 of these new cases will be adults diagnosed with acute myeloid leukemia (AML).

APL - the cancer Pagano has been diagnosed with - is a rare subtype of AML. Only 10% of AML cases, or about 1,300 people, are diagnosed with APL each year.

"Everyone who is diagnosed with acute myeloid leukemia faces a dangerous situation," Cripe told reporters Monday.

What are the symptoms?
Irsay told reporters Monday that Pagano was suffering from fatigue and unexplained bruising, and at the urging of his wife, Tina, the coach took advantage of a week with no game to go to the doctor.

Those are two common symptoms for leukemia, says Dr. Harry Erba, director of hematologic malignancies at the University of Alabama at Birmingham Cancer Center.

Fatigue, shortness of breath with exertion, sometimes a headache and a pale appearance are common symptoms of anemia that comes when the bone marrow isn't producing healthy blood cells, he says.

Pagano's physician told reporters on Monday that "the coach's bruising was due to the fact that his bone marrow was no longer producing in a normal number the factors that are needed for clotting."

What's the prognosis?
Acute leukemia symptoms appear abruptly, says Erba. "Without treatment, a patient's life span is a few weeks to a couple months," he says.

Fifty years ago there was no treatment, but now there's a very effective treatment regimen, Erba tells CNN. He says this specific type of leukemia is "exquisitely sensitive to vitamin A," so for the past 20 years, APL patients have been treated with a combination of standard chemotherapy and a derivative of vitamin A called all-trans retinoic acid or ATRA. Using this drug combination, Erba says, the cure rate for APL was about 70% to 80%.

But the addition of another drug - arsenic trioxide - has led to "the highest cure rates we have ever seen," Erba says. By combining all three treatments, patients have an 80% to 90% cure rate.

The chemotherapy kills cancerous blood cells, says Erba.  That's not what ATRA and arsenic trioxide do. They actually tell leukemic cells to turn into normal cells.  And since normal cells eventually die (that's what they're supposed to do), the combination of chemo and these cancer-cell converting agents is designed to eliminate the cancer cells with the hope that only healthy blood cells will grow back.  It's a complicated regimen that will take many months.

Cripe says he is confident that Pagano will beat the cancer: "the goal of this is to cure the disease.  A definition of a cure is really that the remission has lasted for three to five years, so there's a period of time of where there will be some uncertainty."

For now Pagano faces several weeks of chemotherapy, says Cripe, then after some convalescence, "he will receive several more cycles or months worth of chemotherapy. During that period, he will not be in the hospital, most likely, and he will be able to engage in his normal life to a limited degree."

When and if Pagano can resume his duties as head coach during this season is not clear at this time.

Side effects?
Erba says ATRA, which comes in a pill, can cause headaches and a rash. Arsenic trioxide is given intravenously but is usually very well tolerated, and the main side effects of the chemotherapy (daunorubicin plus cytarabine) are hair loss, some nausea, mouth sores, diarrhea and the risk of infection and needing blood transfusion.

Even though APL is a potentially very deadly cancer, patients do have good treatment options, which is why this coach's prognosis so favorable. In the future, APL patients may be able to skip the chemo entirely and just be treated with ATRA and the arsenic, if current clinical trials pan out. Those study results may be coming in the next few months.

soundoff (25 Responses)
  1. tanlotion1

    I hate this on a personal level for Coach Pagano. I also hate it for the Colts organization. We have have a bad few years, but the bottom line is that something like this really does make you realize where your priorities are. http://pickapartindianapolis.com

    October 1, 2012 at 23:58 | Report abuse | Reply
  2. Hugh Watson

    He will be in my thoughts and Prayers, may God be with him.

    October 2, 2012 at 05:26 | Report abuse | Reply
  3. Tolinhas

    My husband was 1 of the 10% diagnosed with APL in 2009. He had a full year of chemotherapy and is in full remission. Pagano's prognosis is positive if he is treated quickly. Sending positive thoughts for a strong recovery!

    October 2, 2012 at 08:12 | Report abuse | Reply
  4. John

    God Speed Coach

    October 2, 2012 at 08:40 | Report abuse | Reply
  5. Kristen

    Our thoughts and prayers are with Pagano and his family/friends during this time. May God heal Coach Pagano completely. We love our Colts!!

    October 2, 2012 at 10:00 | Report abuse | Reply
  6. E Little

    Get well soon Chuck. I'm keeping you and Tina in my prayers. From your former college and NFL player... ELIQ

    October 2, 2012 at 10:31 | Report abuse | Reply
  7. JJ

    Get well soon Chuck. I'm keeping you and Tina in my prayers. From your former college and NFL player... ELIQ

    Gimmie a break.

    October 2, 2012 at 10:55 | Report abuse | Reply
  8. Not Fiona

    Wish jj and e little could meet in person.
    Bet jj wouldn't be so vocal- ha!
    Hiding behind a keyboard...
    Best wishes to coach.

    October 2, 2012 at 20:52 | Report abuse | Reply
  9. tomhua

    EBook sites http://www.znjnn.com

    October 2, 2012 at 21:59 | Report abuse | Reply
  10. jmw

    My husband just passed last year from this type of cancer. He lasted three years. My prayers go out to the coach. It is a very difficult journey.

    October 4, 2012 at 20:01 | Report abuse | Reply
  11. deep singh

    get well soon Chuck...

    October 6, 2012 at 00:46 | Report abuse | Reply
  12. Bridgett Etherton

    Coach Pagano – you hang in there!! and fight with every inch of engery you may have in your body.. the road will be tough, that's what you tell your team every week..!! but you do the same FIGHT!! and get back on those side lines.. prayers will be with you for a speedy recovery!!!

    October 8, 2012 at 12:24 | Report abuse | Reply
  13. TB

    My wife was diagnosed Aug. 16 with this same disease. Godspeed to both.

    October 28, 2012 at 03:51 | Report abuse | Reply
  14. sha

    My x husband was diagnoised with APL in 07 did 1 round chemo went in remission did 2nd as precauition,,,cancer free sinse,,,,Dr hounded him to keep doing more he refused,,,,careful with the chemo hes glad he stopped.. worked out well,,,,,,,

    November 8, 2012 at 08:56 | Report abuse | Reply
  15. Frances O'Neal

    I was recently diagnosed on March 15, 2013 withAPL. I am presently in the hosp , I have 12 more days in hosp and then out pt treatments. . I feel much better mentally with the knowledge I have gained from this site and knowing Coach Pagano has such a favorable prognosis along with the other people. I do pray for each and everyone because I do know what you are going through!

    April 4, 2013 at 10:41 | Report abuse | Reply
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    The potential of vitamin A, or retinol, in the treatment of a variety of skin diseases has long been recognized, but because of serious toxic effects this substance generally could not be used. The recent development and marketing of two relatively nontoxic synthetic analogues, which are known as retinoids, has made it possible to treat some of the diseases that are resistant to standard forms of therapy.*-*-

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