Book Review

Leukemia

Neoplastic Diseases of the Blood

N Engl J Med 1996; 335:527-528August 15, 1996

Article

Leukemia
Sixth edition. Edited by Edward S. Henderson, T. Andrew Lister, and Mel F. Greaves. 619 pp., illustrated. Philadelphia, W.B. Saunders, 1996. $195. ISBN: 0-7216-5381-2

Neoplastic Diseases of the Blood
Third edition. Edited by Peter H. Wiernik, George P. Canellos, Janice P. Dutcher, and Robert A. Kyle. 1240 pp., illustrated. New York, Churchill Livingstone, 1996. $229.95. ISBN: 0-443-07600-6

The first edition of Leukemia, published by Grune and Stratton in 1958, was a pioneering account by two preeminent hematologists, William Dameshek of Boston and Fred Gunz of Christchurch, New Zealand, of the origins of leukemia, the manifestations of its various forms, and its treatment. Extensively illustrated with photomicrographs, radiographs, and superb watercolor paintings of leukemia cells by Professor Kawakita of Kumamoto City, Japan, Leukemia is a milestone in the literature of hematology. The numerous marginal notes and heavy underlining in my copy bear witness to the excitement the book evoked in a junior hematologist who was struggling to understand what was then an incurable disease. Written 40 years ago, Leukemia makes no mention of oncogenes, cytogenetics, combination chemotherapy, or bone marrow transplantation. Yet it still makes worthwhile browsing if only for its literate style, civilized tone, and humanitarian outlook — a combination rarely found in modern textbooks.

In the first edition of Leukemia, Dameshek and Gunz wrote, “We realize full well that this is but an interim report and that perhaps in a short time, whether it be a year or a decade, a revolution in our understanding and control of the disease may well take place.” Their prophecy was borne out in subsequent editions, which appeared in 1964, 1974, 1983, and 1990. The book was taken over by Saunders in 1990 under the leadership of Edward Henderson and T. Andrew Lister. Now, we have this 1996 revision of the work, in which Mel Greaves joins Henderson and Lister to edit a handsome, folio-sized, and authoritative book on all aspects and forms of leukemia. It is, as the first edition was, an essential work. Numerous charts, diagrams, tables, and photomicrographs (many in color) inform the text and help the reader understand the cytogenetics, immunobiology, morphologic classification, and chemotherapy of leukemia. Its 28 chapters, written by an international group of experts, are extensively annotated with citations up to 1994. The book has a logical organization, a utilitarian layout, and eye-pleasing typography. No technical reference work, especially one about a field as fast-moving as leukemia, can hope to be up to the minute. But with the sixth edition of Leukemia in hand, the reader, whether novice or experienced clinician, can navigate the hazards of polymerase chain reactions, fluorescence in situ hybridizations, peripheral-blood stem cells, and claims of therapeutic efficacy that lurk in the shoals of the current literature. Leukemia maintains the standard of excellence established by the first edition.

At twice the size, Neoplastic Diseases of the Blood stakes out more territory than Leukemia. The organization of the book is curious. There is no introduction, and no central theme weaves the three main topics — leukemia, monoclonal gammopathies, and lymphomas — into a complex whole. Nor is there one point at which the book relates these disorders to normal hematopoiesis and lymphopoiesis, to normal lymphatic tissue (“germinal center” is unmentioned in the index), or the molecular biology of blood-forming cells and lymphocytes. Instead, Neoplastic Diseases of the Blood begins at once with the chronic leukemias, moves on to the acute leukemias, then shifts to myeloma and related disorders, and after a section on the lymphomas, concludes with 13 chapters on supportive care. This arrangement virtually guarantees repetition and difficulties in extracting information. Three chapters deal with immunophenotypes: one in the section on chronic leukemias, a second in the section on acute leukemias, and a third entitled “Immunology of the Lymphomas.” And the reader wanting to know about immunoglobulin variable-region genes in acute lymphocytic leukemia will have to look in the section on myeloma to find the topic. The lack of thematic organization also shows in the book's inconsistencies. The well-written, thorough, and authoritative chapters on myeloma contrast with the single chapter on macroglobulinemia, which could suit a general textbook but not a specialized book like Neoplastic Diseases of the Blood. Descriptions of cytogenetics, scattered throughout, consist mainly of lists, with little about the functional implications of the remarkable rearrangements, deletions, duplications, inversions, and other tricks neoplastic cells can play. And minimal residual disease in the leukemias and lymphomas, an important topic with many ramifications and unresolved questions, merits only a single brief paragraph (by contrast, Leukemia contains a detailed nine-page discussion, with many informative figures and charts).

Neoplastic Diseases of the Blood has fine chapters on myeloma and others equally good, such as the excellent summaries of acute promyelocytic leukemia, therapy-related leukemias, and lymphomas in association with other diseases. Especially noteworthy are the fascinating historical accounts of the leukemias, monoclonal gammopathies, and lymphomas. The lack of a unifying theme detracts from the usefulness of Neoplastic Diseases of the Blood, but many facets of this book will appeal to experienced clinicians.

Robert S. Schwartz, M.D.