Book Review

Clinical Bone Marrow Transplantation: a reference textbook

N Engl J Med 1995; 332:403-404February 9, 1995

Article

Clinical Bone Marrow Transplantation: a reference textbook
Edited by Kerry Atkinson. 749 pp. New York, Cambridge University Press, 1994. $195. ISBN: 0-521-42073-3

It is now more than 35 years since E.D. Thomas and coworkers reported in the Journal that large quantities of bone marrow could be safely infused into humans and that transient engraftment of hematopoietic cells was possible. That work germinated the seed that has grown into an important segment of modern medical practice, with bone marrow transplantation units no longer limited to a few academic centers. The success of the procedure in curing genetic and malignant diseases (albeit tempered by the remaining long road to achieving the goals of minimal toxicity and maximal efficacy) has resulted in dramatically increased use of transplantation of hematopoietic stem cells throughout the world. The majority of hematology–oncology practices in this country now care for at least one patient who has received a marrow or stem-cell transplant. Thus, the time is ripe for a comprehensive, pragmatic, and lucid reference work in this area.

The editor of this multiauthored textbook and its contributors meet these objectives with aplomb. The style is chattily encyclopedic in the discussions and pithy in the diagnostic and therapeutic recommendations. The chapters by an international cast of authors can be read with enjoyment, as if one were talking on the wards with a respected and occasionally droll consultant who is both a teacher and a practitioner of the art. The strength of this work lies in its capacity to provide information in two formats: extended textual discussions of the background for empirical observations in clinical and basic-science research and brief, practical tables summarizing patient care.

The book has 13 sections and 92 chapters dealing with the biologic basis of transplantation, clinical outcomes of different diseases and types of transplantation procedures, diagnosis and management of transplantation-related complications, laboratory issues, and finally, a review of developing areas in the field. The section on practical procedures is a model of clinically useful information; of particular note is a comprehensive chapter containing specific recommendations regarding pretransplantation and post-transplantation procedures and the monitoring of patients. The bibliographies are well chosen and contain references up to 1993.

The authors are not reluctant to take a clinical stand while presenting both sides of controversial issues. Occasionally, different contributors give differing suggestions — for example, about when to use vancomycin in empirical antibiotic coverage for patients with neutropenia. But such divergence adds to the value of the book rather than detracting from it. Specific clinical protocols are often presented in table format, with useful details such as suggestions for diet in patients with graft-versus-host disease.

A number of chapters are applicable to the broader context of caring for patients with cancer. The chapters on the management of mucositis, gynecologic complications, and veno-occlusive disease and the chapter on drug interactions, for example, would be welcome on the oncology ward. Throughout, the book is readable; the chapter on the transplantation of bone marrow from unrelated donors includes the whimsical admonition that couriers transporting cryopreserved stem cells “must have a major international credit card.”

The few faults in this textbook are predominantly those of omission, notable because of the excellence of what is included. I hope that the next edition will include a chapter in the “practical procedures” section devoted to autologous transplantation (of both peripheral stem cells and bone marrow), since this procedure is now moving from academia into the community. Similarly, a chapter on the care of patients more than six months after transplantation and a more detailed discussion of risks to donors and psychological factors would be useful. There are a few distracting errors of spelling, and the figures have a somewhat home-grown appearance, but these are minor quibbles about form rather than substance. One other comprehensive, multiauthored textbook in this field has been published recently: Bone Marrow Transplantation, edited by Stephen J. Forman, Karl G. Blume, and E. Donnall Thomas (Boston: Blackwell Scientific, 1994). These two books, with a 10 to 15 percent overlap among contributors, are both up to date and well written but have somewhat different emphases and styles. They are perhaps complementary rather than competitive, and they could easily stand together on the same shelf.

This textbook should find a home in all bone marrow transplantation units and in the libraries of the larger hematology–oncology practices. It will also be used as a reference by clinicians from other specialties who find themselves asked to consult on the care of patients who are undergoing bone marrow transplantation. As the procedure of hematopoietic-stem-cell transplantation extends further into the management of nonmalignant disease and further still into the world of gene therapy, physicians and scientists can confidently and comfortably turn to this book for education and reference.

Brian R. Smith, M.D.
Yale University School of Medicine, New Haven, CT 06510