Johnny Holland has faced fierce foes for decades, first as a standout tackle in the National Football League, then as a beloved coach with the San Francisco 49ers. But when it comes to being poked by a nurse with a needle, the gridiron warrior shuts his eyes and scrunches his face.

“No matter how many shots I get, it always makes me jump,” he said, grinning.

An inspirational role model to a legion of professional football players, Holland, 58, has an aggressive form of multiple myeloma — a blood cancer that develops in plasma cells, a type of white blood cell. For the last two years, he’s participated in a groundbreaking clinical study at UCSF Health, testing a combination of medications that have kept the cancer at bay.

Holland, who helps guide the 49ers defense as the team’s linebackers coach, is sharing his medical journey to raise awareness about the disease. Multiple myeloma, also called plasma cell myeloma, is among the most common blood cancers, with approximately 36,000 new cases diagnosed annually in the United States, according to the American Cancer Society.

The body generates too many cancerous plasma cells in myeloma, crowding out the normal cells that fight infection. These malignant plasma cells produce abnormal antibodies that do not fight infection and can cause other complications, such as damage to bones. It’s a serious disease with unknown causes, but advances have resulted in longer survival rates and improved the quality of life for patients.

“I tell Johnny and my other patients, we have numerous medical options we can try — we have something in the left pocket, and if it doesn’t work, we have something in the right pocket that we can try next,” said Holland’s physician, Dr. Thomas G. Martin, a leading expert in hematology-oncology and associate director of the myeloma program at UCSF Health, as well as the clinical research director of hematologic malignancies at the UCSF Helen Diller Family Comprehensive Cancer Center. “We always have something coming down the pipeline to help patients.”

Latest weapons to battle cancer

Therapies, ranging from chemotherapy and radiation to stem cell transplantation and immunotherapy, can relieve symptoms and prevent complications. UCSF specialists also test novel treatments – such as the ones in the clinical trial that Holland joined – for patients with newly diagnosed myeloma or relapsed or progressive myeloma. Holland’s trial, which included immunotherapy, uses various cellular treatments to rev up the body’s own immune system to fight the cancer.

“These immunotherapy treatments, including CAR-T therapy and bispecific antibody therapy, are the wave of the future for cancer care,” said Samantha Shenoy, a UCSF Health nurse practitioner who regularly meets with Holland. “Our research is helping to bring hope to patients and is improving outcomes for them.”

Of concern is the rising, disproportionate impact of myeloma – currently 1 in 5 patients diagnosed with the disease in the U.S. is Black, said Martin. Much remains unknown about the disease and why it’s affecting Black people so significantly.

One way to unlock answers is through more clinical studies involving people from a diversity of races. That’s why Holland’s participation in the multiple myeloma clinical study is especially valuable, said Shenoy. “Ensuring clinical diversity is important for advancing health equity,” she said.

’Sometimes, we can be hardheaded’

Holland has spent more than three decades in the NFL as a player and assistant coach. He was a four-year letterman as inside linebacker at Texas A&M University in his home state, then a second-round draft pick in 1987 for the Green Bay Packers – where he played for seven seasons, notching numerous years of 100-plus tackles and helping the 1992-93 team to its first playoff in more than a decade. He was inducted into the Texas A&M hall of fame in 1999, the Cotton Bowl hall of fame in 2000 and the Packers hall of fame in 2001. Since hanging up his helmet, Holland has coached on a half-dozen teams and been with the 49ers the last seven years.

He’s had hip replacements and lives with shoulder and back pain from his playing days. But during the summer of 2019, the pain intensified. He found it difficult to play golf or jog, or even to walk his usual four or five miles daily.

Faith Holland remembers that her stoic husband of 34 years was reluctant to drop by the team physician’s office at Levi’s Stadium. “He was hesitant to see the doctor, even though the doctor is there every day,” she said.

Finally, following the third game of the 2019 season, Holland made a pact with himself: He’d go into the doctor’s office if no one else was there. If someone was, he’d wait until the season ended, months later. “Sometimes, we can be hardheaded,” he said ruefully.

Fortunately, no one else was in the office. The doctor sent Holland for a CT scan and then a blood test. Within a few days, he had been diagnosed with stage III myeloma and began chemotherapy.

That season, the 49ers won the NFC championship and played in Super Bowl LIV, losing to the Kansas City Chiefs. But to Martin, Holland triumphed, because he’d already started medical treatment. “He wouldn’t have made it to the Super Bowl,” said Martin. “He would have been too tired or too ill.”

In the UCSF clinical trial, Holland initially received medications weekly, then biweekly, then monthly. He’s become so accustomed to treatments that typically he returns to coaching duties the same day.

“I don’t like to be late to practice,” he smiled. “The team has been absolutely awesome. Coach (Kyle) Shanahan, (General Manager) John Lynch, the players – they got shirts saying they had my back. These dudes really have my back.”

Early cancer symptoms can be mistaken for getting older

Holland recently lay on a hospital bed in the infusion center at the UCSF Helen Diller Medical Center at Parnassus Heights. Through the window over his right shoulder was Kezar Stadium, where the 49ers played for many years. He lifted his shirt as oncology registered nurse Julie McCluggage administered two shots into his abdomen. “This is life-saving,” he said quietly.

“The medical staff makes you feel like you matter,” said Faith, who has two grown children with Holland. “When you’re in a fight like this one, you need it. Doctors and nurses are like coaches – they really care about their patients.”

Typically, multiple myeloma symptoms are masked at the outset since they can be common, especially in older people. “Back pain is one of the most common symptoms, and it happens pretty much in everybody 50 and older,” said Martin.

Later on, symptoms can include broken bones and repeated infections. Advanced disease symptoms might include nausea, vomiting, constipation, and weakness or numbness in the legs.

Holland, who once played in the NFL without missing a single game in five years, is still pushing his body like a younger athlete – devoting more than a dozen hours a day to coaching four years after his diagnosis. Now that he’s completed chemotherapy and adjusted to his monthly shots, his weight has returned along with his appetite. The neuropathic pain affecting his nerves bothers him at times, but it hasn’t worsened. And he still climbs all four flights of stairs whenever he visits the UCSF myeloma clinic.

“It gets the heart pumping,” he said. "The more active I am, the better I feel. I try to listen to my body. My energy has been great and I’m feeling great.

“I tell players it isn’t the big things you do, it’s the little things you do and the way you make people feeI. I tell them to try to have a positive mindset. We all have certain things we go through in life, so try to impact people in a positive way.”

This article was originally published January 2024 by the University of California, San Francisco News Center. It is republished with permission.