Book Review

Haematological Oncology: Clinical Practice

N Engl J Med 1993; 329:1283October 21, 1993

Article

Haematological Oncology: Clinical Practice
By D. Quaglino and F.G.J. Hayhoe. 485 pp., illustrated. New York, Churchill Livingstone, 1993. $195. ISBN: 0-443-04297-7

This book is richly illustrated, with 480 color plates. In many respects it is the offspring of Colour Atlas of Haematological Cytology, an earlier work by Hayhoe and R.J. Flemans (3rd ed. London: Wolfe Medical, 1991). Its parentage is recognizable in the excellent photomicrographs and the generally uncomplicated writing style.

The authors have “set out to integrate the clinical aspects and therapeutic approaches [of hematologic oncology] with the biologic and functional concepts necessary for their understanding.” In this undertaking they have been successful, in terms of cataloguing recent national trials of therapeutic protocols conducted in Great Britain and to a lesser extent those in Italy. It is my view, however, that although this may be a valid view of the therapeutic universe, it is a rather narrow one, especially since the authors do not dissect out and examine some of the key issues in the current treatment of leukemia, such as the role of consolidation and “late intensification” therapy, the question of the “best” consolidation program, the influence of the age of the patient on the choice of treatment, and the relative merits of autologous bone marrow transplantation, allogeneic transplantation, and conventional chemotherapy in both acute and chronic leukemias.

One could argue that if there is a role for a textbook of hematologic cancer, it is to present the day's most important questions and the most promising answers clearly and concisely. The authors might have made their arguments clear had they used tables and line graphs summarizing survival in relation to treatment to help us evaluate various therapeutic options. We are sometimes left in doubt about what they regard as best for patients.

The classic clinical manifestations of malignant hematologic diseases are well presented, to the accompaniment of many pages of color pictures. The photographs of suitably ghastly cutaneous lesions will almost certainly be intriguing to new students of disease. Less so will be the discussions of the biology of disease, which are often sketchy and sometimes out of date. This may be inevitable in a rapidly changing field such as the biology and treatment of leukemia. Although the authors have cited a few recent review articles at the end of each chapter, the addition of a bibliography of either classic or current references would be useful in building a framework of understanding.

Ideas about the origins of leukemias are evolving rapidly. In many cases, we have a detailed knowledge of the molecules that are deranged and cause disease. This knowledge has already been translated into molecular diagnostics and even therapy. Moreover, hematologic cancers are increasingly catalogued on the basis of their surface antigenic markers, chromosomal rearrangements, and molecular abnormalities. The authors make a valiant effort to integrate this diverse information, and they come up with a logical, although idiosyncratic, classification of disease. Whether this classification will find widespread use outside the environs of Cambridge, England, where the authors worked for many years, is moot.

To be fair, it is difficult to know what a modern textbook of hematologic cancer should contain, or to define its target audience. One could argue for many different focuses: the natural history of disease, classic histochemical analyses, disease classification based on immunophenotyping and molecular analyses, molecular pathogenetic mechanisms, or a summary of controversies about what constitutes the best therapy. Readers will probably find some of these areas well covered in Haematological Oncology, and other areas not so well fleshed out. Almost certainly all will agree that at $195, this book is expensive.

Martin J. Cline, M.D.
UCLA Center for the Health Sciences, Los Angeles, CA 90024