Book Review

Multiple Myeloma

N Engl J Med 1997; 336:1460-1461May 15, 1997

Article

Multiple Myeloma
Edited by Gösta Gahrton and Brian G.M. Durie. 219 pp. London, Arnold, 1996. (Copublished with Oxford University Press, New York.) $89.50. ISBN: 0-340-57603-0

I picked up this book with keen anticipation. Although multiple myeloma is a rare tumor, it is apparently becoming more common, and it is a fascinating paradigm for all cancers. Multiple myeloma introduced us to monoclonality before cloning became fashionable and is encountered in almost every medical specialty. Hematologists and oncologists will claim control, but the tumor invades the practices of immunologists, biochemists, metabolic physicians, nephrologists, and microbiologists, with secondary spread to cardiologists, neurologists, and even orthopedic surgeons.

The book begins well. Kyle's chapter on the history of the disease is a peach — well researched, full of anecdotes, and wonderfully illustrated. How many of today's physicians know that Korngold and Lipari gave their initials to kappa and lambda chains? I also liked Bergsagel's chapter on epidemiology, with its telling point that since the myeloma-associated mortality rates in Olmsted County, Minnesota, have not changed since 1945, it is likely that the increase seen elsewhere is simply the result of more comprehensive case ascertainment — the rest of the world catching up with the Mayo Clinic. Caligaris-Cappio and Gregoretti's chapter on basic concepts is similarly clear, concise, and well written.

The task of editing a multiauthored book is complex. Authors seldom keep to deadlines; one author submits a contribution promptly that is out of date by the time the book is published, while another treats the deadline as the start of negotiations and eventually makes all the other contributions out of date. Fields inevitably overlap, so that authors review the same literature and say the same things in different chapters. Even worse, after reviewing the same literature, they come to different conclusions. In this book, t(11;14) is characterized as an important chromosomal translocation in myeloma and also as a rare and trivial one, and autocrine interleukin-6 secretion by myeloma cells is called an important mechanism and a laboratory artifact due to contamination with stromal cells.

As far as I can discover, no one has yet been cured of multiple myeloma. Samson's chapter on combination chemotherapy elegantly illustrates the vanity of yet more letters in the alphabet cocktail, and subsequent chapters detailing even more aggressive attacks on the bone marrow, with or without stem-cell support, would not encourage me to approach this disease, if I acquired it, with anything other than terror.

The curate, not wishing to offend his host, said that his rotten egg was “good in parts.” This book is better than that, yet it could be better still. No surgeon participated in its preparation, but I believe that the editors should wield the scalpel. Duplication is unforgivable. Some of the chapters might have ended up considerably shorter, but as Bataille demonstrates in his discussion of myeloma-induced bone changes, short chapters can be very rewarding.

What I should really like is for the editors to impose more of their own voice on the book. At times, the literature is extensively quoted, but we do not find out what the author thinks of it, let alone the opinion of the distinguished gentlemen whose names have induced us to buy the book.

Terry J. Hamblin, D.M.
Royal Bournemouth Hospital, Bournemouth BH7 7DW, United Kingdom