Childhood Leukemias by Ching-Hon Pui

Childhood Leukemias



Download Childhood Leukemias




Childhood Leukemias Ching-Hon Pui
Language: English
Page: 976
Format: pdf
ISBN: 0521825191, 9780521825191
Publisher: Cambridge University Press

From The New England Journal of Medicine

As Pui comments in the preface, the need for this book is based on the relative paucity of books in which all aspects of childhood leukemias are collated, despite the rapid expansion of scientific and clinical knowledge of these diseases. The book is intended to "meet the needs of a diverse readership," including clinicians, trainees, and scientists. Overall, I feel that Pui and his distinguished team of contributors (largely from the United States and many from the editor's institution, St. Jude Children's Research Hospital) have achieved this aim.

The book is laid out in four separate sections: introductory chapters (including an interesting account of the historical development of treatment of leukemia and a clear review of the epidemiology and causes of leukemia in children), cell biology and pathobiology, evaluation and treatment, and complications and aspects of supportive care. The text is generally easy to read, and despite the admission in the preface of "differences of opinion and interpretation among the various contributors," I feel that there are many more areas of general agreement than disagreement among the chapters. My only concern in this respect is that I sometimes had to look in several different chapters to find information about specific points, but as I read through the book I was impressed by the common approach. The index is comprehensive, with only a few minor omissions. The illustrations, particularly the color plates, are of high quality. The references in most chapters are up to date, relevant, and generally comprehensive.

I approached this book primarily as a practicing clinician whose workload is dominated by childhood leukemia, but I found several of the chapters about cell biology stimulating, particularly those on immunophenotyping and cytogenetics. These will serve as useful references in the future, and they help to clarify understanding of complex areas in this rapidly evolving field. I also enjoyed the chapter on pharmacokinetic and pharmacodynamic aspects, although I was rather surprised that the extensive work from St. Jude Children's Research Hospital on the individualization of chemotherapy in children with acute lymphoblastic leukemia did not figure prominently in this chapter. Indeed, this topic appears to have been consciously omitted; it is mentioned only in a table in the chapter concerning treatment of the disease. The chapters on the acute and late complications of treatment of leukemia are well written and comprehensive, and the chapter on infectious complications includes detailed coverage of the importance of viral infections, which are often underrecognized in children with leukemia. However, I was surprised by some omissions, such as a discussion of the use of steroids as adjunctive treatment in severe Pneumocystis carinii pneumonia and the use of hand washing as probably the single most important aspect of infection control in susceptible, immunocompromised children.

The chapters that focus on the individual diseases include concise and informative descriptions of clinical and hematologic features, particularly the chapters on acute lymphoblastic leukemia and myelodysplastic and myeloproliferative disorders. There is a useful table in the chapter on acute lymphoblastic leukemia that summarizes the relevant results and applicable clinical information from recently completed clinical trials. In the chapter on transplantation, there are useful tables that summarize the outcome of several single-institution and registry series of cases of transplantation for acute lymphoblastic leukemia and acute myeloid leukemia. However, I would have preferred to see more detailed discussion of the various strategies of treatment used by different collaborative groups, particularly in Europe and North America, concerning the intensification of treatment in acute lymphoblastic leukemia, the indications for allogeneic bone marrow transplantation, and the choice of a donor in bone marrow transplantation. Although the information is summarized well, there is little discussion of many of the current areas of uncertainty and controversy, such as the treatment of relapsed acute lymphoblastic leukemia with either further chemotherapy or allogeneic bone marrow transplantation. I was also disappointed that clinical aspects of one of the remaining difficult problems in childhood leukemia, that of infantile acute lymphoblastic leukemia, received relatively little space, when I was hoping to find more discussion of current strategies of intensified treatment, and of bone marrow transplantation, in these patients.

As a test of the clinical usefulness of this book, I tried to look up a few specific clinical problems that have vexed our unit recently. There are short but helpful sections on acute mixed-lineage leukemia and acute undifferentiated leukemia in the chapter on immunophenotyping. However, there is no specific mention of congenital acute leukemia, and there is little information about the therapeutic implications of acute leukemia in Down's syndrome.

Nevertheless, overall, Childhood Leukemias is an excellent book that will only improve with subsequent editions, particularly if the clinical sections are expanded and more information about rare but problematic clinical scenarios is included. I would not hesitate to recommend this book to pediatric oncology and hematology units and to refer trainees to several of the excellent chapters. I would certainly have appreciated access to it during my training.

Reviewed by Roderick Skinner, M.B., Ch.B., Ph.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
--This text refers to an alternate

edition.

'... comprehensively referenced and the indexing is simple to use ... informative and relevant ... I would commend the book to anyone looking for an up to date and comprehensive reference monograph on childhood leukaemia.' The Bulletin of The Royal College of Pathologists

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