Book Review

Innovative Leukemia and Lymphoma Therapy

N Engl J Med 2009; 360:313January 15, 2009

Article

Innovative Leukemia and Lymphoma Therapy
(Basic and Clinical Oncology. 35.) Edited by Gertjan J.L. Kaspers, Bertrand Coiffier, Michael C. Heinrich, and Elihu Estey. 598 pp., illustrated. New York, Informa Healthcare, 2008. $279.95. ISBN: 978-0-8493-5083-2

Research on the biologic basis of leukemias and lymphomas has revealed new molecular entities with distinctive genetic and epigenetic abnormalities. Correct diagnosis of these disorders affects their clinical management because they involve genetic markers that can be used to stratify patients to risk-adapted therapies. The therapeutic relevance of compounds aimed at distinct molecular targets in cancer cells has become clear since the successful use of imatinib in the treatment of chronic myelogenous leukemia.

Innovative Leukemia and Lymphoma Therapy is a complete and up-to-date synopsis of the new targeted treatments that are being developed for leukemias and lymphomas. All the chapters are written by world-renowned experts who summarize the innovative developments that are being brought from the bench to the clinic.

The first four chapters of the book cover new aspects of the molecular diagnosis of leukemias and lymphomas and the resulting changes that should be considered in the planning and implementation of new trials that are intended to test new classes of compounds that target specific molecular aberrations. The remaining chapters, in which therapeutic applications are discussed, include historical perspectives of the fields, summaries of standard therapies, and broad discussions of the biologic rationale, safety, and applicability of each of the innovative therapies that are considered. Different classes of compounds are covered in the book, ranging from molecules that target epigenetic aberrations to molecules that are designed to target specific genetic alterations, such as mutations in tyrosine kinases or the disruption of pathways that are involved in more general mechanisms of malignant transformation. The question of the clinical utility of other treatments such as vaccines, nucleic acid–based therapies, radiotherapy, and stem-cell transplantation is also revisited. The biologic rationale for adapting these approaches to treatment to the evolving concepts of molecular targeting in hematologic malignancies is discussed in great detail. The editors should be congratulated for including near the end of each chapter a section entitled “Clinical Perspectives for the Next Five Years,” in which the expert authors anticipate the future directions of the compounds that are under discussion and assess the likelihood that they will be successfully integrated into treatments for specific molecular subsets of leukemia and lymphoma.

The omission of a chapter on prognostic markers in leukemias and lymphomas is unfortunate. In clinical practice, we continually see patients with cytogenetic and molecular markers that are associated with adverse or favorable outcomes, which are not mutually exclusive. Furthermore, in certain cases these prognostic markers have also served as therapeutic molecular targets (such as the internal tandem duplication of fms-related tyrosine kinase 3 gene [FLT3] in acute myeloid leukemia). Hence, it is legitimate to ask how these markers should be prioritized and integrated into modern algorithms to guide the treatment of patients with leukemia or lymphoma.

Guido Marcucci, M.D.
Clara D. Bloomfield, M.D.
Ohio State University Comprehensive Cancer Center, Columbus, OH 43210
clara.bloomfield@osumc.edu