Volume 3 of Cambridge Medical Reviews: Haematologic Oncology provides detailed reviews on 10 topics of current interest in the field of hematologic malignancies. The text is organized into 10 chapters and has 22 contributors.
The initial chapter, on the epidemiology of non-Hodgkin's lymphoma, is a compendium of epidemiologic data from multiple sources. The strength of this chapter resides predominantly in the six tables used to summarize the epidemiologic data. This tabulation will provide a useful reference for anyone requiring worldwide epidemiologic data on these diseases.
The second chapter, authored by David Onions, is a brief introduction to the role of viruses as etiologic agents of leukemia and lymphoma. This discussion is well written and easily comprehensible to the practicing oncologist.
The third chapter on bone marrow stroma microenvironment, by M.I. Gordon, acts as a basic introduction to this complex, yet relatively poorly understood, area of hematopoiesis.
The fourth chapter is an analysis of treatment for multiple myeloma, with an emphasis on the Medical Research Council (MRC) trials. While the discussion of the literature as a whole puts many issues into proper perspective, the emphasis on the MRC trials, which are listed by their sequential numbers, is somewhat confusing and detracts from the readability of this text. The chapter would have been more valuable for the practicing oncologist if it had presented an overall review of chemotherapy for multiple myeloma, rather than emphasizing the more general results in comparison to the MRC trials.
The fifth chapter, by D. Samsom, reviews the field of bone marrow transplantation for multiple myeloma. It discusses separately the use of allogeneic, syngeneic, and autologous transplants. It also explores important issues, including the graft-vs-myeloma effect and the use of dose-intensification regimens. The chapter is well organized, and while written from a dose-intensification perspective, points out that the final answer about the value of autologous transplantation vs chemotherapy is not yet in.
The sixth chapter, on peripheral blood stem cells for therapeutic use, is written by C.A. Juttner and L.B. To. This chapter describes both the theoretical and practical advantages of peripheral stem-cell transplantation, and illustrates the advantage of peripheral progenitor transplants over marrow-based transplants.
The seventh chapter, written by D.J. Culligan and A.K. Burnett, is entitled "The Laboratory Aspects of Myelodysplasia." This chapter starts with the morphologic definitions of the myelodysplastic syndromes, as determined by the French-American-British (FAB) Group in 1982. It then discusses the impact of cytogenetics, immunohistochemistry, immunophenotyping, progenitor growth studies, and molecular biologic analysis on this field. This chapter helps the clinician understand these modern advances, in particular, how these tools allow for a better understanding of the pathophysiology of these diseases when compared to morphologic analysis alone.
The eighth chapter, authored by C. Chomienne et al, is a brief discussion of one of the most exciting treatment results in oncology over the last decade--the use of retinoids in acute promyelocytic leukemia. This group's discussion of the clinical activity of retinoids in this disease is relatively brief, and includes a hypothesis of how retinoic acid induces complete responses in patients with acute promyelocytic leukemia.
The ninth chapter, on the cytogenetics of acute lymphoblastic leukemia, is a useful introduction to this very confusing field. Table I is a useful summary of the more important chromosomal abnormalities seen in this disease. Unfortunately, both the table's overall layout and use of abbreviations make it difficult to read.
The final chapter, on fungal infections complicating hematologic malignancies, is a useful review of this area for the practicing oncologist. This chapter is practical in its approach, in that it avoids the often confusing, detailed listing of all possible fungal infections seen in such patients. Rather, it focuses on the most common agents and the best approaches for treating infections caused by these pathogens.
Overall, the third volume of Haematologic Oncology is filled with a variety of informative chapters for the practicing physician. In general, the information is presented in a fashion that should be useful to the treating oncologist. One drawback is that the topics chosen are quite diverse, which disrupts the organization of this text.
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