Book Review

Hematopoietic Stem Cell Transplantation

N Engl J Med 2001; 344:463-464February 8, 2001

Article

Hematopoietic Stem Cell Transplantation
Edited by Anthony D. Ho, Rainer Haas, and Richard E. Champlin. 604 pp., illustrated. New York, Marcel Dekker, 2000. $185. ISBN: 0-8247-0273-5

Hematopoietic stem-cell transplantation was undoubtedly one of the most important medical advances in the second half of the 20th century. The 1990 Nobel prize in physiology or medicine was awarded to Joseph E. Murray and E. Donnall Thomas for their discoveries concerning organ and cell transplantation in the treatment of human diseases. This award served to acknowledge not only the enormous contributions made by these pioneers in the field of organ and hematopoietic stem-cell transplantation, but also the importance of transplantation technology to clinical practice.

Hematopoietic stem-cell transplantation has led to the cure of diverse forms of cancer, bone marrow failure, hereditary disorders of metabolism, and severe congenital immunodeficiencies, which otherwise would have been fatal. During the past three decades, outstanding progress has allowed us to extend the indications for such treatment to diseases previously regarded as not amenable to this therapeutic approach. It has led, especially in the past decade, to an exponential increase in the number of transplant recipients worldwide. Thus, more than 13,000 new cases of hematopoietic stem-cell transplantation per year have been recently reported to the International Bone Marrow Transplant Registry. Moreover, this number accounts for only 40 percent of the allogeneic transplantations performed around the world and 50 percent of the autologous transplantations in North and South America. This considerable increase in the number of transplantations has been paralleled by impressive basic and applied research into the uses of hematopoietic stem-cell transplantation. Attempts to compile the accumulating knowledge and convey the current understanding of hematopoietic stem-cell transplantation are therefore particularly welcome.

This multiauthored monograph contains reviews of topics the editors regard as having major current importance in the field of hematopoietic stem-cell transplantation. The list of authors includes more than 100 of the most prominent specialists from all over the world, each of whom wrote a single chapter, either alone or in collaboration. The 34 chapters are grouped into nine sections of various lengths.

The first section addresses cytokine modulation of hematopoiesis, with special emphasis on the biology and potential usefulness of novel cytokines (thrombopoietin, the flt3 ligand, and stem-cell factor) and the complex cellular mechanisms involved in the engraftment and self-renewal of hematopoietic stem cells. The second section, “Animal Models,” contains three chapters that review investigations relevant to hematopoietic stem-cell transplantation in humans that were carried out in ovine, canine, and murine models. The next three sections, which could have been condensed into a single section, tackle CD34+ selection, tumor-cell purging, and ex vivo expansion of progenitor cells from different perspectives. Chapters selected for the sixth, seventh, and eighth sections cover advances in allogeneic and autologous transplantation. The last section of the book reviews progress in and prospects for gene and immune therapy.

Individually, most of the chapters are highly informative and contain carefully compiled and extensive lists of references. However, the book has some unavoidable weaknesses. From a thematic standpoint, one wishes for more extensive coverage of certain important issues — which may even have deserved individual chapters — such as transplantation involving bone marrow from HLA-mismatched and unrelated donors, transplantation of umbilical-cord blood, and donor-lymphocyte infusions. An index that included the headings listed in each chapter would have increased the efficiency of use for readers. The subject index at the end of the book, although useful, does not overcome this deficiency. Even so, I agree with the editors' hope that this book “will be a resource for scientists and physicians alike who are searching for an overview of the scientific background, clinical advances in allogeneic and autologous transplantation, and future prospects of hematopoietic stem and progenitor cell technology.”

Miguel A. Sanz, M.D., Ph.D.
Hospital Universitario La Fe, 46009 Valencia, Spain

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