Book Review

Bone Marrow Transplantation

N Engl J Med 1995; 333:672September 7, 1995

Article

Bone Marrow Transplantation
Edited by Stephen J. Forman, Karl G. Blume, and E. Donnall Thomas. 942 pp., illustrated. Cambridge, Mass., Blackwell Science, 1994. $225. ISBN: 0-86542-253-2

Anyone bold enough to predict 50 years ago that by the coming turn of the century a substantial proportion of hematologic diseases, and some nonhematologic diseases, would be treated successfully by clinicians collecting marrow cells from one person and transfusing them into another — admittedly with sophisticated ancillary maneuvers to prepare the patient and to continue support after he or she receives this “hematopoietic stem-cell transplant” — would have encountered some incredulity, if not ridicule. But this, of course, is precisely what has happened in the past 40 years. Much of this remarkable progress is documented in encyclopedic detail in the latest anthology of papers on the subject, Bone Marrow Transplantation, a collection of 70 separate contributions covering the history, scientific basis, current techniques, complications, and clinical results of hematopoietic stem-cell transplantation — of both allografts and autografts — to treat a wide variety of diseases.

The book is not really a textbook, for various reasons. It is too personal, and the enthusiasm of the authors is too obvious. A photograph at the beginning of the preface shows Dr. Thomas receiving his Nobel prize in 1990 from King Carl Gustaf of Sweden — a remarkable achievement, not least because Thomas was the first clinical scientist for many years to receive the award for medicine. The book is dedicated to patients and their families, and a series of prominent pictures shows the smiling faces of patients cured by transplantation procedures, many of whom would otherwise undoubtedly have died.

The choice of chapter content and authorship is generally successful, in part because of the fact that the editors have eschewed parochialism and instead recruited experts from both sides of the Atlantic who are the acknowledged leaders in their fields. The chapters on the biology of the HLA system, biostatistical methods, the psychological aspects of bone marrow transplantation, and the ethical and legal problems encountered by donors deserve special mention. The sections on the treatment of individual diseases can serve as textbook-type references for readers in need of a quick update. One of the most fascinating contributions comes from Martin Cline, who looks at the status of marrow transplantation in the next century, predicting important developments in stem-cell purification, the prevention of graft-versus-host disease and infection, major progress with gene therapy, and intriguingly, the need for transplantation being entirely superseded by less drastic therapy by the 2060s. We shall see.

The book is not perfect. I suppose we must accept the publisher's decision to save money by grouping all the color plates into a single section of the book, but there are too many histologic images, some poorly selected. Elsewhere in the book some of the black-and-white figures could be better deciphered with the aid of a magnifying glass. There are some omissions. Surprisingly, syngeneic transplantation receives only cursory mention, and the problem of confirming homozygosity is not covered. Monoclonal antibodies that have proved useful for T-cell depletion get no mention. A significant omission is any discussion of techniques to maintain or substitute for fertility after transplantation. But these are just quibbles about a truly impressive book that can and will come even closer to perfection in future editions. Until then, this version is quite simply a must for the bookshelf of any person who has even the vaguest interest in the biology or practice of marrow, blood, or umbilical-cord hematopoietic stem-cell transplantation.

John M. Goldman, D.M.
Royal Postgraduate Medical School, London W12 ONN, United Kingdom