Hematopoietic Cell Transplantation, edited by Drs. Thomas, Blume, and Forman, is an excellent updated second edition of their comprehensive textbook designed for both practitioners involved in transplantation and those interested in the science of stem-cell transplantation. The new edition, which reflects the contributions of 150 authors, is 50% larger than the initial textbook due to the inclusion of several new sections. Also, updated material throughout the book summarizes scientific progress in the field; references are current up to 1998. The title has been changed from Bone Marrow Transplantation to the current one to reflect the fact that bone marrow is no longer the primary source of hematopoietic cells used for autologous and allogeneic transplantations.
The book is divided into eight logically organized sections, each with a comprehensive review of critical issues. Section I focuses on the scientific basis for hematopoietic cell transplantation and includes interesting new chapters on the histocompatibility complex, new uses for stem-cell transplantation, the molecular aspects of stem-cell renewal, and chapters on the “state of the art” of gene transfer, and early clinical trials of gene therapy using hematopoietic cells. Also new to this section of the book are well-written chapters on the molecular techniques used to evaluate minimal residual disease following hematopoietic transplantation, as well as chapters on the use of adoptive immunotherapy.
Section I concludes with scholarly, yet comprehensive, chapters on immunologic issues of transplantation, ranging from induction of tolerance to the pathophysiology of graft-vs-host responses. Many of the previously existing chapters have been restructured by new authors to give them a fresh and updated perspective.
Section II—an entirely new addition for the second edition—deals specifically with patient-related issues in transplantation. Although short and to the point, the chapters nicely cover the critical issues faced by patients undergoing transplantation, as well as the invaluable roles played by other members of the transplant team, including nurses, psychologists, and ethicists. Of particular interest is the chapter on ethical issues in transplantation, which features carefully discussed clinical scenarios that must be confronted by patients, their families, and the clinical team.
Section III is also new, examining the relative “explosion” of additional sources of hematopoietic cells used in transplantation that has occurred since the first edition was published in 1994. This section includes new chapters on cord blood and in utero transplantation and the use of peripheral blood stem cells for allogeneic transplantation, as well as a new, informative chapter on the structure and function of bone marrow registries.
Section IV deals with the myriad of medical complications that can and do occur prior to, during, and following transplantation, and the management of these problems. For the clinician, these chapters provide an invaluable resource to guide the management of the common, as well as the rare and difficult, medical issues that arise, ranging from graft-vs-host disease and infections to specific organ dysfunction and pain management. Of specific interest to me were chapters on the hemolytic complications of transplant and a discussion of the long-term complications following transplantation.
Sections VI and VII comprehensively review the data on allogeneic and autologous transplantation for specific disease entities. Chapters in these sections have been expanded, and importantly, updated to include long-term follow-up data, as well as data from newer trials. Within the section on allogeneic transplantation, new chapters cover transplantation for juvenile myelomonocytic leukemia and chronic lymphocytic leukemia. Another informative chapter explores options for the management of relapse after allogeneic transplantation, with a focus on donor lymphocyte infusions.
In this edition, separate chapters have been written on the outcome of transplantation for acute leukemias in adults vs children, taking into account the biological differences in the diseases and the pathophysiology of the distinct groups. The section on autologous transplantation has also been expanded to include more chapters on solid tumor transplants and the use of autologous transplantation for nonmalignant diseases, including human immunodeficiency virus infection, amyloidosis, and autoimmune disorders. There is also a well-written chapter on immune strategies designed to prevent relapse following autologous transplantation. The book concludes with an interesting, futuristic description of potential issues in the field of hematopoietic transplantation in the 21st century.
The book is very well edited, with a consistency of format and clear, graphic depiction of the data. The second edition of Hematopoietic Cell Transplantation is a worthy successor to the initial textbook and will be a valuable reference guide for physicians, other members of the medical team, and scientists interested or involved in the fascinating and complex field of hematopoietic stem-cell transplantation.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
