Book Review
Acute Myelogenous Leukemia
N Engl J Med 2007; 357:2208November 22, 2007
- Article
Acute Myelogenous Leukemia
(Contemporary Hematology.) Edited by Judith E. Karp. 426 pp., illustrated. Totowa, NJ, Humana Press, 2007. $149. 978-1-58829-621-4.When I started my clinical training in hematology around 1970, the outcome of patients with acute myeloid (or myelogenous) leukemia (AML) was invariably poor. The diagnosis was based solely on morphology. As a result, it was not always possible to distinguish AML from acute lymphoblastic leukemia with confidence. Only a few textbooks about leukemias had been published, and one devoted to AML, if available, would have been a thin pamphlet. In my own library, I have a book on adult leukemias from the Cancer Treatment and Research series published by Kluwer (now Springer) in 1982. In those days, combination chemotherapy had made its appearance, cytogenetics was beginning to dig its way into clinical practice, and allogeneic bone marrow transplantation was an emerging treatment.
In the subsequent 25 years, the genetic distinction between molecular subtypes of AML and their prognostic implications, immunophenotyping for precise identification of the lineage and stage of differentiation of the cells, modern supportive care with antibiotics and transfusions, variants of hematopoietic stem-cell transplantation, and treatment stratification according to cytogenetically defined risk factors have all become parts of the standard of clinical care. Acute Myelogenous Leukemia reflects the diversity of developments that have accumulated in the field during the past two decades. These advances are discussed in separate sections of the book. They not only are interesting from a biologic perspective but also are directly relevant to the diagnosis, prognosis, and recognition of distinct categories of AML. The recognition of these categories affects decisions about treatment and is relevant to developmental therapeutics.
An Electron Micrograph of a Myeloblast Containing an Auer Body. Special categories (including acute promyelocytic leukemia, AML in childhood, AML in older adults, myelodysplasia-related AML, and treatment-related AML), principles of treatment, and new classes of drugs are the subjects of a series of concise chapters. The book highlights developments in genomics and extensively reviews prominent contributions from phase 1, phase 2, and phase 3 clinical trials as well as developments in clinical pharmacology. These chapters furnish a high-quality comprehensive overview.
As the book presents a snapshot of the state of the art in the continually changing area of clinical research in AML, it is inevitable that some important recent advances are missed. For instance, there is no attempt to place the emerging genetic markers of prognosis (mutations and aberrant expression of genes) into an integrated perspective. Nor does the book include a review of high-throughput techniques for diagnosis such as gene-expression profiling, single-nucleotide polymorphisms, and microRNA profiling arrays. I did not find a summary of the subject of minimal residual disease, nor is there a discussion of mutations of the nucleophosmin-1 gene, the most common acquired mutation in AML, detectable in one third of cases. Despite these criticisms, however, I can warmly recommend this book as a comprehensive, up-to-date, and detailed yet concise source of information about AML.
Bob Löwenberg, M.D., Ph.D.
Erasmus University Medical Center, 3000 CE Rotterdam, the Netherlands
