SPOTLIGHT
“ For AML , therapy is intensive , with kids in the hospital for up to a month at a time ,” Dr . Stevens said . “ This treatment can last about six months and kids are not involved in any school-based sports during that time .”
Children and adolescent athletes with AML can work to maintain their level of conditioning through physical therapy , she added . However , some kids with AML will require bone marrow transplantation , which makes for a longer road to recovery .
“ One of my favorite success stories is a runner whose coach noticed a change in his performance – he was running at the back of the pack . That led to a trip to the physician and a diagnosis of AML ,” Dr . Stevens said . “ The patient did great , underwent transplant , and is now back playing varsity sports .”
With a diagnosis of ALL , treatment can last more than two years , and the first nine months entail intensive treatment . “ We tend to keep the majority of these kids out of school and out of sports ,” Dr . Stevens said . “ We don ’ t want them to get any infections that could slow or delay their chemotherapy .”
Although the drugs typically used for ALL have less cardiotoxicity , treatment with the mainstay steroids can affect performance .
“ There are a variety of things that could potentially decrease children ’ s ability to effectively participate in sports after they are done with the intensive phase of treatment ,” she said . “ Quite a few people may never return to participating at the same level as they had before because of the toxicity of treatment .”
The Athletic Advantage
The three examples of professional athletes with hematologic conditions are powerful , but athletes are just like any other patient , Dr . Lossos said . Not all will be cured of their disease and not all will be able to return to athletics . There is a whole spectrum .
“ Leukemias , for example , can be very debilitating and patients will experience muscle waste and weight loss ,” Dr . Lossos said . “ This type of disease doesn ’ t spare totally healthy people . Healthy people can still die .”
However , athletes diagnosed with a hematologic disorder have some built-in advantages .
At the time of diagnosis , pediatric athletes are often better conditioned and at an appropriate weight , Dr . Stevens said , two factors that help minimize treatment-related toxicities .
The same is true in adults , said William G . Wierda , MD , PhD , professor of medicine in the department of leukemia at the University of Texas MD Anderson Cancer Center . Dr . Wierda was involved in the treatment of NFL player David Quessenberry who was diagnosed with non-Hodgkin T-cell lymphoma shortly after being drafted by the Houston Texans in 2014 . 7
“ Athletes tend to be fit and healthy , and take better care of themselves than the average person does ,” Dr . Wierda said .
Their advantage is not only physical , but mental . “ Because of athletes ’ innate competitive nature , they often also have a great deal of self-discipline and tend to be motivated and invested in getting the most out of their treatment to return to athletics .”
In addition , many athletes have built-in support systems , Dr . Stevens added .
“ The loss of sport is profound , but I have found that with team sports , the kids and coaches tend to be very close ,” Dr . Stevens said . “ This can be incredibly beneficial because it provides another layer of support .”
Put Me in , Coach !
Whether the patient diagnosed with a hematologic disorder is an athlete or not , the goal is always curative treatment , Dr . Wierda said .
“ We won ’ t usually abbreviate treatment without good cause if it would compromise our ability to cure their disease ,” Dr . Wierda said . “ That is always our primary objective .”
Still , he acknowledged that it is possible to avoid certain drugs that might cause long-term damage to the lungs and heart . That is because , for many athletes , the ultimate goal after undergoing treatment for a hematologic disorder is a return to the sport that they love . The ability to return is , of course , based on whether the patient ’ s disease has gone into and remains in remission .
Dr . Stevens said that , for children with leukemias who experience remission , she typically requires a one-month delay before returning to play , after significant immunosuppression has ended . “ That recommendation is well received by the parents , if not by the patients ,” she said . “ For the rare patient who cannot or does not want to delay engagement , we will create a modifiable conditioning plan with a coach so that they can be prepared to start playing as soon as it is safe .”
One of Dr . Stevens ’ patients was diagnosed with Philadelphia chromosome – positive ALL at 13 . After his battle with ALL , he was focused on being able to play football in his freshman and sophomore years of high school .
“ Coming back my freshman season was much easier because I knew I had time on my side and I only had to get to a freshman level of playing ,” the patient told ASH Clinical News . A relapse at the end of his sophomore football season required a bone marrow transplant and radiation .
“ I didn ’ t have much time to get to a senior level of strength and endurance , but I worked hard to be able to put back on the pads and get back on the field ,” he said .
In adult athletes the wait time may be similar , Dr . Wierda added .
The Road to Recovery
“ As patients transition from intensive treatment to maintenance , they can begin to increase their physical activity and exercise and get back to a more aggressive training schedule ,” Dr . Wierda said , adding that he has had the rare patient who continues to do physical activity during the intensive treatment phase , albeit with extreme caution .
“ Team physicians are also brought into the loop when I ’ m caring for a professional athlete ,” Dr . Wierda said . “ The team physicians will often do their own assessment to determine if an athlete is ready to return .”
During his treatment for Hodgkin lymphoma , Conner continued non-contact training with the University of Pittsburgh . Upon completing his treatment , he was able to get back to the field , Dr . Marks said .
“ When the Steelers were thinking about drafting him , they reached out to me about any long-term side effects to be concerned about in terms of James ’ endurance , performance , and likelihood of injury ,” Dr . Marks said . “ None of those things were a concern .”
For Rizzo , it was not possible to play during active treatment , Dr . Lossos said , but he began to train after therapy ended and he prepared himself to go back after one year .
“ I assessed his health for ability to go back to play ,” he said . “ Once we reached the one-year mark , he was doing well and we encouraged him to start to train .”
Dr . Lossos emphasized that some people diagnosed with cancer see “ victory ” as eliminating the cancer . “ In Rizzo ’ s case , though , it was clear from the first moment we met that the only victory for him would be playing baseball ,” he said .
Rizzo was able to make his major league debut with the San Diego Padres in 2011 , three years after his disease went into remission .
Patients Off the Field
Just like any other survivor , professional athletes undergo routine follow-up .
“ I see Rizzo about once a year ,” Dr . Lossos said . “ We are looking for lymphoma recurrence , as well as checking for routine things that may happen secondary to therapy .”
Rizzo also stays active in the cancer community that he joined when he was diagnosed . “ Anthony was really a model for other patients ,” Dr . Lossos said . “ It is important for patients to know that somebody like him has had this disease , gone through all of the same things they are experiencing , and survived .”
Similarly , Conner started supporting other patients even while he was still undergoing treatment , Dr . Marks said .
“ James would walk around the treatment area and give patients encouragement ,” Dr . Marks said .
Garrett helps to build awareness of SCD as well . He recently organized a sickle cell awareness basketball team – SCD Hoops – that is competing in The Basketball Tournament 2021 broadcast on ESPN .
A new direction in the career path of Dr . Steven ’ s patient was also realized after his diagnosis . Instead of continuing to pursue football after high school , he switched his focus to physical therapy . “ My plan is to help others who want to get back to the sport they love and help build a connection with them so they know nothing is impossible ,” he said . “ Eventually , I would love to have my own sports medicine and rehabilitation facility so I can focus on helping people who were like me .”— By Leah Lawrence
References
1 . Merck Manuals . International Prognostic Score in Hodgkin Lymphoma . https :// www . merckmanuals . com / medical-calculators / IPS . htm . Accessed July 1 , 2021 .
2 . Mondello P , Musolino C , Dogliotti I , et al . ABVD vs BEACOPP escalated in advancedstage Hodgkin ’ s lymphoma : results from a multicenter European study . Am J Hematol . 2020 ; 95:1030-1037 .
3 . Seshachalam A , Karpurmath SV , Rathnam , et al . Does interim PET scan after 2 cycles of ABVD predict outcome in Hodgkin lymphoma ? Real-world evidence . J Glob Oncol . 2019 ; 5:1-13 .
4 . Johnson P , Federico M , Kirkwood A , et al . Adapted treatment guided by interim PET-CT scan in advanced Hodgkin ’ s lymphoma . N Engl J Med . 2016 ; 374:2419-2429 .
5 . Straus DJ , Dlugosz-Danecka M , Connors JM , et al . Brentuximab vedotin with chemotherapy for stage III or IV classical Hodgkin lymphoma ( ECHELON-1 ): 5-year update of an international , open-label , randomised , phase 3 trial . Lancet Haematol . 2021 ; 8 : E410-E421 .
6 . U . S . Food and Drug Administration . FDA approved L-glutamine powder for the treatment of sickle cell disease . Published August 8 , 2017 . Accessed July 6 , 2021 . https :// www . fda . gov / drugs / resources-information-approved-drugs / fda-approved-lglutamine-powder-treatment-sickle-cell-disease .
7 . Klemko R . David Quessenberry , Spreading Hope . Sports Illustrated . Published December 12 , 2017 . Accessed July 6 , 2021 . https :// www . si . com / nfl / 2017 / 12 / 12 / davidquessenberry-houston-texans-cancer .
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