© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 9, 754,
May 3, 2000
© 2000 Oxford University Press
BOOK REVIEW |
Aplastic Anemia: Pathophysiology and Treatment
H. Schrezenmeier, A. Bacigalupo, eds. Cambridge (U.K.): Cambridge University Press, 2000. 391 pp., illus., $110. ISBN 0-521-64101-2
Correspondence to: Robert A. Brodsky, M.D., Department of Oncology, Division of Immunology and Hematopoiesis, The Johns Hopkins Oncology Center, Cancer Research Bldg., Rm. 242, 1650 Orleans St., Baltimore, MD 21231 (e-mail: rbrodsky{at}jhmi.edu).
Aplastic anemia is a rare hematopoietic disease with an incidence of two to six new cases per million people in the United States. For decades, the disease has fascinated clinicians and researchers in diverse fields, including hematologists, stem cell biologists, immunologists, and hematopoietic stem cell transplanters. This intense study of aplastic anemia has led to novel advances in bone marrow transplantation, autoimmunity, and hematopoiesis.
Aplastic Anemia: Pathophysiology and Treatment is a new multiauthored textbook that is devoted to covering the basic biology and management of acquired aplastic anemia and Fanconi’s anemia. The authors, mostly from the European Group for Blood and Marrow Transplantation, are recognized experts in this field. The text is focused, well organized, and extremely well written. The book is divided into four sections; the first three discuss community-acquired aplastic anemia and the last is devoted to Fanconi’s anemia. Part I does an outstanding job in addressing the pathophysiology of aplastic anemia and covers the areas of stem cell biology, cytokines, apoptosis, and autoimmunity as they relate to the disease. The intriguing relationship between aplastic anemia and other clonal disorders, such as paroxysmal nocturnal hemoglobinuria and myelodysplastic syndromes, is also discussed in this section. Part II, entitled "Epidemiology and Clinical Features of Acquired Aplastic Anemia," is somewhat dry, and most of the information provided can be found in standard hematology or internal medicine textbooks. Photomicrographs of pathology specimens and improved figures and tables would help to improve this section. The bulk of the text, Part III, is devoted to the treatment of acquired aplastic anemia. This section provides a detailed description of the use of bone marrow transplantation, immunosuppressive therapy, and hematopoietic growth factors to treat severe aplastic anemia. Newer approaches, such as the use of high-dose cyclophosphamide without stem cell transplantation, are also briefly discussed. Chapter 16 attempts to provide a consensus document for treating aplastic anemia. This chapter succeeds in providing general guidelines, but it does not reach a clear consensus. The final section concentrates on the inherited bone marrow failure disorder, Fanconi’s anemia. This section is especially informative and clearly organized.
A table referred to in chapter 16 does not appear. With that exception, most of the figures and tables in the book are informative and well organized. The references are reasonably current for a textbook with citations through 1998; however, several references are referred to on numerous occasions in multiple chapters, which is redundant.
Not all of the investigators who study aplastic anemia will agree with the management recommendations promulgated by the authors, especially in some of the more controversial areas, such as when to recommend allogeneic bone marrow transplantation or the type of immunosuppressive therapy; however, the authors are to be commended for providing a relatively balanced view of these difficult topics. Despite its minor flaws, Aplastic Anemia: Pathophysiology and Treatment is an outstanding reference for both adult and pediatric hematologists who treat patients with bone marrow failure. Basic scientists interested in the mechanisms of hematopoiesis and bone marrow failure will also find this to be a useful reference. In short, the text provides an accurate and comprehensive overview of aplastic anemia.
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