Roman Reigns Leukemia: What Type & How He Beat It

In October 2018, Roman Reigns (real name Leati Joseph Anoaʻi) stood in a WWE ring and told millions of fans that his leukemia had returned after 11 years in remission. He relinquished his Universal Championship title that night, stepping away from wrestling to fight chronic myeloid leukemia (CML) for the second time. He was first diagnosed at age 22 in 2007, achieved remission, and then relapsed in 2018 at age 33.

Because both can elevate atypical lymphocytes, a positive mono test is sometimes confused with leukemia — here is the connection.

The good news: Reigns announced his remission just four months later, in February 2019, and returned to WWE programming almost immediately. His story is one of the most high-profile examples of how dramatically CML treatment has improved — a cancer that was once a near-certain death sentence now has a 5-year survival rate exceeding 70%, and many patients live essentially normal lifespans with ongoing treatment.

What Type of Leukemia Does Roman Reigns Have?

Roman Reigns has chronic myeloid leukemia (CML). He has never publicly specified his exact subtype or treatment regimen, but CML is distinct from other leukemias in several critical ways that help explain his story — particularly how he was able to achieve remission, relapse, and then achieve remission again relatively quickly.

CML is driven by a specific genetic abnormality called the Philadelphia chromosome, a translocation between chromosomes 9 and 22 — written as t(9;22). This creates an abnormal fusion gene called BCR-ABL1, which produces a protein that causes white blood cells to multiply uncontrollably.

The discovery of this molecular target revolutionized treatment. Unlike many cancers where chemotherapy is the frontline approach, CML is primarily treated with tyrosine kinase inhibitors (TKIs) — oral medications that specifically block the BCR-ABL1 protein. This is why Reigns was able to continue living a physically demanding life and return to wrestling so quickly after his relapse.

Roman Reigns’ Leukemia Timeline

How Leukemia Types Compare

To fully appreciate Reigns’ diagnosis, it helps to understand where CML fits among the four major leukemia types. Each behaves very differently in terms of who it affects, how fast it progresses, and how it’s treated.

Reigns was diagnosed at 22, which is younger than the median age for CML but not unheard of. CML accounts for roughly 15% of all adult leukemias, with about 9,000 new cases diagnosed annually in the United States.

How CML Is Diagnosed

CML is often caught incidentally on routine blood work before a patient even feels sick. The hallmark finding is a markedly elevated white blood cell count — sometimes 100,000/µL or higher (normal is 4,500–11,000/µL) — with a characteristic “left shift” showing immature granulocytes at various stages of development.

Diagnostic Workup

• Complete blood count (CBC) with differential: Elevated WBC with basophilia and immature myeloid cells across the maturation spectrum
• Peripheral blood smear: Shows the full range of myeloid precursors — myelocytes, metamyelocytes, bands, and segmented neutrophils
• Bone marrow biopsy: Hypercellular marrow with granulocytic hyperplasia; confirms diagnosis and determines disease phase
• Cytogenetics/FISH: Detects the Philadelphia chromosome t(9;22)
• PCR for BCR-ABL1: Quantifies the fusion transcript; used for diagnosis and ongoing monitoring of treatment response

Once treatment starts, patients are monitored with quantitative PCR (qPCR) every 3 months. The goal is to achieve a “major molecular response” — defined as a BCR-ABL1 level ≤0.1% on the International Scale. Deeper responses (BCR-ABL1 undetectable) are associated with the possibility of eventually discontinuing treatment in select patients.

CML Treatment: Why Roman Reigns Recovered So Fast

Before 2001, the median survival for CML was 3–5 years, and the only curative option was a bone marrow transplant with its significant risks. Everything changed with the FDA approval of imatinib (Gleevec), the first tyrosine kinase inhibitor.

Reigns has never publicly confirmed which TKI he takes, but current first-line options include:

• Imatinib (Gleevec): The original TKI; 400 mg daily. Well-tolerated with decades of safety data. 10-year overall survival ~84%.
• Dasatinib (Sprycel): Second-generation TKI; achieves faster, deeper responses than imatinib. 100 mg daily.
• Nilotinib (Tasigna): Another second-generation TKI; 300 mg twice daily. Faster molecular responses but carries cardiovascular risk.
• Bosutinib (Bosulif): Used first-line or after failure of other TKIs.
• Ponatinib (Iclusig): Third-generation TKI reserved for patients with the T315I resistance mutation.

The fact that Reigns relapsed after 11 years in remission suggests either he stopped TKI therapy (a supervised TKI discontinuation, known as treatment-free remission or TFR) and the disease returned, or the disease developed resistance to his initial TKI. In either scenario, switching to or restarting a TKI typically restores remission — which aligns with his rapid 4-month turnaround in 2018–2019.

The Three Phases of CML

CML progresses through three distinct phases, and catching it early matters enormously:

• Chronic phase: Where most patients are diagnosed (~90%). Manageable with TKIs. This is almost certainly the phase Reigns was in during both diagnoses.
• Accelerated phase: Disease becoming more aggressive. Blasts 15–29% in blood or marrow. Requires treatment change.
• Blast crisis: Resembles acute leukemia. Blasts ≥30%. Median survival drops to 3–6 months without aggressive intervention. Often requires combination chemotherapy plus TKI, and possibly stem cell transplant.

Living With CML: What Daily Life Looks Like

One of the most striking aspects of Reigns’ story is that he maintained an elite athletic career while living with CML. This is actually consistent with what most chronic-phase CML patients experience on TKI therapy — the disease can be managed with a single daily pill.

That said, TKIs aren’t without side effects. Common ones include:

• Fatigue and muscle cramps (especially with imatinib)
• Nausea and diarrhea
• Fluid retention and periorbital edema
• Pleural effusions (particularly with dasatinib)
• Cardiovascular events (more common with nilotinib and ponatinib)

Patients on TKIs require regular monitoring — not just PCR testing, but also metabolic panels, liver function tests, and depending on the drug, echocardiograms or pulmonary function tests. For an athlete like Reigns, managing these side effects while performing at an elite level is a genuine feat.

Can CML Be Cured?

This is the question patients ask most, and the answer is nuanced. TKIs don’t technically “cure” CML in most cases — they suppress it. Think of it like blood pressure medication: the drug controls the condition, but the underlying tendency remains.

However, a growing body of evidence supports treatment-free remission (TFR). In clinical trials like STIM, EURO-SKI, and DESTINY, roughly 40–60% of patients who achieved deep molecular responses (BCR-ABL1 undetectable for ≥2 years) were able to discontinue TKI therapy and remain in remission. The other 40–60% relapsed — usually within 6 months — and almost all regained remission after restarting their TKI.

This framework may explain exactly what happened with Roman Reigns: deep remission → TKI discontinuation → molecular relapse → TKI restart → rapid re-remission.

Allogeneic stem cell transplant remains the only definitively curative option, but given the risks (graft-versus-host disease, transplant-related mortality of 10–20%), it’s reserved for patients who fail multiple TKIs or progress to blast crisis.

Impact of Roman Reigns’ Announcement

When Reigns made his announcement on October 22, 2018, it was one of the most-watched segments in recent WWE history. The Leukemia & Lymphoma Society reported a significant spike in website traffic and donations in the days following his disclosure. Be The Match, the national bone marrow donor registry, also saw increased registration.

His openness accomplished something that public health campaigns struggle with: it made a young, physically imposing man the face of leukemia. CML doesn’t discriminate by fitness level, and seeing a world-class athlete battle the disease helped destigmatize cancer diagnoses, particularly among younger men who are statistically less likely to seek medical care.

Key Takeaways

• Roman Reigns has chronic myeloid leukemia (CML), first diagnosed in 2007, with relapse in 2018 and second remission by early 2019.
• CML is driven by the Philadelphia chromosome and treated primarily with oral tyrosine kinase inhibitors — not traditional chemotherapy.
• TKIs have transformed CML from a fatal diagnosis to a manageable chronic condition with near-normal life expectancy for most patients.
• Approximately 40–60% of patients who achieve deep molecular remission can successfully stop treatment under medical supervision.
• Relapse after TKI discontinuation is common but typically responds quickly to restarting therapy.

Frequently Asked Questions

Is Roman Reigns still in remission?

As of his last public statements, yes. Reigns announced his second remission in February 2019 and has been actively wrestling since then, including a record-setting 1,316-day reign as Universal Champion from 2020 to 2024. He has not publicly reported any further relapses.

Can you die from CML?

CML can be fatal, particularly if it progresses to blast crisis or if a patient doesn’t respond to TKI therapy. However, for patients diagnosed in chronic phase who respond to TKIs — which is the vast majority — life expectancy approaches that of the general population. A 2017 study in the Journal of Clinical Oncology showed that CML patients achieving major molecular response had survival rates nearly identical to age-matched controls.

Is CML hereditary? Should Roman Reigns’ family be worried?

CML is not considered a hereditary cancer. The Philadelphia chromosome is a somatic (acquired) mutation, meaning it develops in a single blood-forming cell during a person’s lifetime — it isn’t passed from parent to child. Having a family member with CML does not significantly increase your risk. Reigns’ Samoan wrestling family members are not at elevated genetic risk because of his diagnosis.

How often does CML relapse after remission?

If a patient stays on TKI therapy, true relapse (loss of molecular response) occurs in roughly 5–10% of cases and often signals resistance that can be managed by switching TKIs. If a patient discontinues TKI therapy in a supervised treatment-free remission attempt, approximately 40–60% will see the disease return, usually within the first 6 months. Virtually all of these patients regain remission upon restarting treatment.

What symptoms should I watch for if I’m worried about leukemia?

See a doctor if you experience unexplained persistent fatigue, recurrent fevers or infections, easy bruising or bleeding (nosebleeds, bleeding gums, petechiae), unintentional weight loss, bone pain, or a feeling of fullness below the left ribs (enlarged spleen). A simple CBC blood test is the first step, and abnormal results will prompt further workup. Many CML patients, however, are diagnosed with no symptoms at all — the disease is caught on routine lab work showing an elevated white blood cell count.