Playing for Keeps

Leukemia, a deadly cancer of the blood, can sneak up on an otherwise healthy person—even former Dallas Cowboys coach Tom Landry.

OVER THE DECADES, Dallas Cowboys fans have disagreed vehemently over Coach Tom Landry’s play calling, his selections on draft day, even his colorless, Bible-toting persona. But one thing everyone who ever saw him stride the sidelines could agree on was that he was the very personification of good health: tanned and svelte, clear-eyed and vigorous—especially, it seemed, after he retired and, in his seventies, became a walking advertisement for the virtues of clean living.

So it came as a shock in early May when his family confirmed that the 74-year-old football legend was undergoing treatment for leukemia, the rare but deadly cancer of the blood that strikes some 28,000 people each year. The coach’s son and business partner, Tom Landry, Jr., was quick to reassure a concerned public: “Fortunately,” he said, “this was diagnosed at an early stage and treatment was begun immediately.”

Still, leukemia is one of the most terrifying types of cancer, and worrisome questions persisted even as Landry took up residence at Baylor University Medical Center in Dallas for a thirty-day protocol of chemotherapy. Some wondered how an old man could come down with a cancer widely thought to strike mainly children; others couldn’t understand how someone who appeared to be so healthy could suddenly have a life-threatening condition.

Breakthroughs in the diagnosis and treatment of cancer, especially in the past decade, have begun to cut the disease down to size in the eyes of the public. Although two of every five of us will develop it, more than half of that group will survive it (and the percentage is going up every day). Cancer has become a more common and less daunting foe.

Except for leukemia. This cancer continues to have a firm grip on the public’s imagination, thanks in part to its role in sensational news stories such as the leukemia cluster in East Woburn, Massachusetts, in the seventies, which was traced to industrial waste and was the subject of the book and movie A Civil Action. And it remains the cancer of choice for melodramas, such as the John Grisham novel The Rainmaker, the fictional story of a young leukemia victim’s battle against an insurance company that refuses to cover his treatment.

Although science has long known that leukemia is not just a childhood disease—indeed, nine out of ten victims are adults—we still don’t really know what causes it. Genetics plays a role, as do certain environmental agents, such as cigarette smoke and industrial chemicals, benzene in particular. But both genetics and the environment account for relatively small percentages of leukemia’s overall incidence. The majority of cases appear to be just bad luck. “It’s pretty infrequent that we know what causes leukemia in an individual,” says Dr. Robert Collins, the director of the bone and marrow transplant program at the University of Texas Southwestern Medical Center at Dallas. “It just happens.”

The good news is that treatment has improved radically since the sixties, when leukemia was still claiming the lives of more than 80 percent of its victims. Still, the five-year survival rate is only 42 percent. And it remains a disease that can kill a victim with startling rapidity. But perhaps it’s the stealthy nature of leukemia, more than anything else, that makes it especially feared. Sooner or later, most cancers will announce their presence to a victim by means of mysterious pain or a suspicious lump or an inexplicable cough. But leukemia flies under the radar: Its warning signs are fatigue, malaise, lingering infections, shortness of breath, frequent bruising, bleeding gums, and cuts that are slow to heal, which aren’t likely to strike most people as symptoms of a potentially lethal disease. Hence it can sneak up on an otherwise perfectly healthy person.

That certainly seems to have been the case with Tom Landry. Since retiring in 1988 after 28 consecutive seasons as the head coach of the Cowboys (including a record 20 consecutive winning campaigns and 5 trips to the Super Bowl) and being inducted into the National Football League’s hall of fame in 1990, Landry was leading a quiet and relatively anonymous life that revolved around business ventures with his son and charity work, helping sponsor charity golf tournaments and working for organizations such as the Fellowship of Christian Athletes and the Lisa Landry Childress Foundation—named for his youngest daughter, who died of liver cancer in 1995—which promotes organ donorship. Giving a motivational speech or appearing in a television commercial, he still looked at least ten years younger than his age, despite his famous baldness.

But in early May, during a routine checkup, doctors discovered he was anemic—a condition that is a frequent precursor of leukemia. At least one longtime friend had noticed that the coach looked peaked. “I saw Tom two weeks ago at his golf tournament and, in fact, I introduced him at a dinner and he didn’t look good,” former Cowboys president and general manager Tex Schramm told reporters after learning of Landry’s diagnosis.

 Discovered in 1845 by the eminent German biologist Rudolf Virchow, leukemia (the word means “white blood” in Greek) arises from genetic damage—either inherited or caused by something in the environment—that prevents new white blood cells produced in the bone marrow from maturing properly; those cells that do mature are rendered dysfunctional in other ways. The ripple effect of this glitch in cellular replication is catastrophic: There is nothing more elemental to human life than blood. Its red cells carry oxygen, the most basic fuel of life; its white cells fight off infections and other toxins; and its platelets, which promote proper blood clotting, are critical to the healing of wounds.

When the bone marrow begins producing immature or useless white cells, the first damage is to the body’s immune system, where the bad cells soon crowd out the functional ones, leaving the victim more vulnerable to infection. As the number of abnormal white cells in the bone marrow mounts (like all cancer cells, they tend to reproduce much more rapidly than normal cells), the

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