INDIANAPOLIS –Colts first-year Head Coach Chuck Pagano has been diagnosed with Acute promyelocytic leukemia (APML) and will be lost to the club for a period of time.
Pagano, who turns 52 on Tuesday, was diagnosed with the illness last week when the club observed its bye week. Pagano sought evaluation for bruising last Wednesday, was admitted to the IU Simon Cancer Center and began treatment that night.
"It's been a very difficult week," said Colts Owner and CEO Jim Irsay. "The coach was feeling some fatigue over the past few weeks. (He) had noticed some bruising on his body that at first he thought could have been from contact on the field coaching, or playing with his grand kids. Eventually through talking to his wife, Tina, she said, 'You need to check that out because the bruising appears to be more prominent.'
"We did have the coach go in and get fully evaluated on the bruising and his fatigue. The conclusion came down that he did have leukemia. Obviously, it's a very difficult blow for him, for his family."
APML accounts for approximately 10 percent of adults with Acute myeloid leukemia (AML) diagnosed annually in the nation, an estimated number of cases ranging between 1,000 and 1,300.
AML is a cancer of the bone marrow, the tissue responsible for the production of the peripheral blood cells required for health. The bone marrow, as a rule, is distributed in the adult vertebrae, proximal long bones and pelvis.
The normal bone marrow is capable of the regulated production of white blood cells, red blood cell and platelets throughout a person's lifetime due a population of marrow cells capable of self-renewal and differentiation into any type of mature blood cell. These primitive cells are the stem cell. In AML a cell from the stem cell pool becomes incapable of maturing into healthy blood cells and accumulates as immature cells or blasts. The diagnosis of AML is made when more than 19 percent of the marrow nucleated cells are blasts (the normal percentage is less than five percent).
"We always talk about, 'God, family, football,' in that order. … I am optimistic," said Irsay. "I feel with every fiber in my body, and I know Chuck feels the same way, that he can beat this thing. When you get such a difficult diagnosis like this, it's tough. At the same time in terms of other diagnosis (from diseases that may be untreatable), that's not the case here. We feel, and he feels, that he will battle and get this disease in remission. It's a marathon, no question about it."
Pagano's physician, Dr. Larry Cripe, indicated Pagano is seeking a full recovery and will do what is necessary to achieve it.
"The goal of the treatment is to cure the disease," said Cripe. "That means that he returns to a fully functional life, the life that he's worked so hard to earn, and he is looking forward to leading the Colts to some Super Bowls. The process is long and complicated. We're just starting right now. For the next several weeks, this will be day-by-day. We'll be vigilant and do everything we can to help him reach a full recovery."
Cripe indicated Pagano's condition is a relatively favorable form of acute leukemia in terms of a likelihood of remission and of him achieving a cure. There are specific treatments for the disease, and those procedures started on Pagano last Wednesday night.
Pagano is in the induction phase, which will last about four-to-six weeks from last Wednesday.
During that time, Pagano will complete chemotherapy. He will receive transfusions, antibiotics and medications to minimize possible side effects of treatments. He can go home when he feels like it, when his blood counts are safe and when other transfusions are not required.
Cripe said most people with this variety of leukemia will achieve a complete remission, though months of attention to the process are necessary. Pagano will remain under observation and treatment periodically for about two years. Cripe underscored the goal is remission, and a time frame definition is that the remission has lasted for three-to-five years.
Cripe said Pagano knows he has received chemotherapy and he feels good. Cripe did not estimate when Pagano could return to the Colts, given the physical nature of his job. He also would not cite statistics of remission, but said Pagano and his family think the rate sounds good.
Cripe said there is no catching leukemia early or later, and treatment is the same, as is the outlook for recovery. In general, bone marrow transplant is not used for this variety of the disease. Cripe looks forward to working with Pagano on his job return and the approach to his life, and he says the coach is "gung-ho" on fighting the disease.
Cripe said indications are that Pagano is benefiting to the treatment at this time. Cripe described the treatments as arduous and that for the next several weeks Pagano is at risk for complications day-by-day. The uncertainty is difficult, but Pagano is in good health otherwise. Pagano is in a protected environment, but is not in isolation. Tina, has stayed with him.
Cripe estimated there are approximately 1,300 APML cases across the country annually, with a typical median age range of 40-to-45 being most common for the onset. The median range for AML cases is about 70 years of age.
"I'm very optimistic he will beat this thing," said Irsay. "I think it's unlikely that he will be 'all-in' as a head coach this season. It's probably not in the cards where he's going to be able to come back and be 'all-in' this season. … There are peaks and valleys.
"Chuck is very dear to this organization as a head coach. The special thing about Chuck is he's a 'salt of the earth' man. You aspire to be the type of man he is. He's going to be greatly missed in terms of his intensity, his energy, his leadership."
Indianapolis is 1-2 after three games, but Irsay says Pagano has had enough time to establish his program and that in his absence, there is one goal as the Colts host Green Bay this Sunday.
"He has had the chance (this season) to set the tone for the players, coaches and what he expects," said Irsay. "In meeting with the team and coaches, there is nothing more than we want to get that Green Bay game ball and have a victory game ball and be able to walk that into the hospital and put that in his hands.
"That's our goal. I know we will pull together. It's been a very difficult day, a lot to take in for our coaches, players and organization."
Pagano joined the Colts on January 25 after four seasons with Baltimore, the final one as defensive coordinator. This is Pagano's 29th year in coaching, his 11th in the NFL. His prior NFL posts have been with Cleveland (2001-04), Oakland (2005-06) and Baltimore.
Offensive Coordinator Bruce Arians will take over the field direction of the Colts in Pagano's absence. Arians re-joined the Colts this year after serving with Pittsburgh from 2004-11. Arians spent the 1998-2000 seasons with Indianapolis as quarterbacks coach. He was the offensive coordinator with Cleveland from 2001-03, and served the last five seasons in the same capacity with Pittsburgh. Arians was the head coach at Temple from 1983-88, his only role in that capacity.
"Bruce Arians is going to be our interim head coach," said Irsay. "It was Chuck's wishes and certainly had my blessing and (General Manager) Ryan's (Grigson) blessing. We're fortunate to have a veteran coach like Bruce to lead the team. Everyone is up to the task of doing that extra bit of work that everyone needs to do for us to maintain and play at a high level.
"It is important for him (Pagano) to stay engaged in the team. … He is ready to take this fight on, and he is a fighter."
Leukemia is a cancer of blood-forming cells in the bone marrow.
Normal blood contains white blood cells, red blood cells, and platelets. All three types of blood elements develop from one immature cell type, called blood/marrow stem cells, in a process called hematopoiesis.
These stem cells divide and develop to a more developed, but still immature precursor, called a "blast," which then develops through several more stages, into a mature blood cell. In leukemia, immature cells accumulate in the blood and within organs of the body. They are not able to carry out the normal functions of blood cells.
This process takes place in the bone marrow, which is the soft spongy material found in the center of long bones and pelvis.
Too many immature cells disrupt platelet function. Platelets, along with certain plasma proteins, help form clots once blood vessels are damaged or cut.
Each of the two major types of leukemia, myelogenous and lymphocytic, include both acute and chronic forms.
Acute essentially refers to a disorder of rapid onset. In the acute myelocytic leukemias, the abnormal cells grow rapidly and do not mature. Most of these immature cells tend to die rapidly. In the acute lymphocytic leukemias, growth is not as rapid as that of the myelocytic cells. Rather, the cells tend to accumulate. Common to both types of leukemia is their inability to carry out the functions of healthy white blood cells.
Leukemia is newly diagnosed in about 47,000 people each year in the United States.
Survival rates in leukemia have risen dramatically in the last 40 years with improvements in diagnosis and treatment.