John Metchie III’s road back: Long-term prognosis for patients with his form of leukemia is favorable

To reach the heights John Metchie III has, you’ve got to bring 60 minutes of fight every game. Now, Metchie will bring months of fight to a battle much bigger than any game he’s ever played.

Metchie, drafted earlier this year by the Houston Texans, has been diagnosed with acute promyelocytic leukemia, a condition that will almost surely keep him off the football field for the 2022 season. But the long-term prognosis for patients with APL is a favorable one, and a leukemia expert notes that the treatment regimen, while harsh and continuous, could very well help Metchie return to full action.

Metchie carved his name into Alabama legend when he caught the pass that ended the four-overtime Iron Bowl last season. That was the capstone of a season that included 96 catches for 1,142 yards and eight touchdowns, part of a run that took Alabama all the way to the national championship game.

Metchie wasn’t able to play in that game, a loss to the University of Georgia, since he’d suffered a torn ACL in the SEC Championship. Still, the Texans had seen enough to deal three picks to the Cleveland Browns in order to select him 44th in this year’s draft. He was working his way back from the ACL injury and expected to be ready for training camp.

On July 24, though, Metchie announced that his life had taken a different path. “Recently I was diagnosed with APL (Acute Promyelocytic Leukemia), the most curable form of Leukemia,” he said in a statement released by the Texans. “I am currently receiving great medical care, am in good spirits and I expect to make a recovery at a later point in time. As a result of this diagnosis, I will likely not be playing football this season. My main focus will be on my health and recovery.” He thanked his fans for their support, and tributes to Metchie’s tenacity soon arrived.

“John has overcome every challenge placed in front of him in his life with toughness and determination, and we are behind him every step of the way in his fight against Leukemia,” Alabama head coach Nick Saban said in a statement.

For Metchie, the real work begins now. Dr. Douglas Smith, professor of oncology at Johns Hopkins University’s Sidney Kimmel Comprehensive Care Center — who has not treated Metchie and cannot comment on his specific case — offered a breakdown of the traditional diagnosis route that APL patients follow. APL in particular is a notable form of leukemia because of its initial dangers, but also its long-term treatability.

“It’s the most dangerous form of acute leukemia in the first one to two months, but the most curable form afterward,” Smith said. “Patients with APL have a tendency toward bleeding and clotting irregularly. … Once the bleeding problem gets stabilized and the leukemia problem gets under control, it is the most curable form of acute leukemia in adults.”

Acute leukemias, by their very definition, come on quickly, in a matter of weeks or months. Patients with APL — a rare form of leukemia — often show symptoms of bleeding or unexplained bruising.

“To put someone at bleeding risk on a football field, even in light pads — one crack of the head, even with the great protective helmets, could put him at tremendous risk for bleeding,” Smith said. “The fact that this was discovered before intensive training for this upcoming season is a real blessing.”

Unlike other forms of leukemia, APL responds well to a distinctive, nontraditional combination of drugs: all-trans retinoic acid, or ATRA, and arsenic trioxide. While higher-risk patients undergo more traditional forms of chemo, low-risk patients work through a regimen of on-off weeks of pills and injections that take about seven to eight months.

“There is a dramatically better outcome for patients if you get them through the first two months of bleeding risk and treatment risk,” Smith said. Metchie could also benefit from the expertise of Houston’s MD Anderson Cancer Center, a world-renowned cancer treatment facility.

The prognosis over the long term for patients with APL is a favorable one, with a recovery rate of over 90 percent, as opposed to the 30 to 40 percent of patients with more common forms of acute myeloid leukemia.

“It’s hard therapy,” Smith said. “It’s hard to maintain strength, hard to maintain endurance, hard to maintain conditioning. For sure, it will take time to recover.” Smith noted that patients such as Metchie will require frequent monitoring to ensure the leukemia does not recur.

“It’s everybody’s hope and expectation,” Smith said, “with successful therapy, that patients can return to their pre-diagnosis activity level with no major risk.”