G B Faguet (ed)
Published by Humana Press (2003)
ISBN: 1-5882-9009-9 414 pages plus index
At the beginning of my career, chronic lymphocytic leukemia (CLL) was an obscure condition for which there were no answers; no precise ideas on etiology, diagnosis, or prognosis, and no therapy that had any long-term impact. “Put him on Chlorambucil and send him home” would be the consultant physician’s instructions (and entire repertoire of management).
Now we have a rather different view of this disease, and an entire textbook describing the explosion of knowledge about it over the last 10 years. This book contains chapters by many of the key figures in the laboratory and clinical world of CLL and encompasses sections on the molecular genetics and cell biology of the disease, the relevance of this information to prognosis and recent data on new clinical therapeutic developments.
The highlights? Aside from collating basic and diagnostic laboratory science with clinical advances into one textbook, I was impressed by the chapters on genetics and molecular biology of CLL, which synthesised much of the recent advances in pathogenesis and their prognostic relevance. In particular, the description of the division of CLL cases into those with somatic hypermutations in the variable region of the immunoglobulin heavy chain gene, which have an excellent prognosis, and those with unmutated VH genes, which have a poor prognosis.
There is an excellent introductory chapter on the natural history of the disease, and a superb summary of clinical management by Guillame Dighiero. Terry Hamblin has also written a whimsical chapter on the cellular origins of CLL. Glimpses of possible future curative strategies are given in chapters on combination chemotherapy, monoclonal antibody treatment, bone marrow transplantation and gene therapy.
The downsides? Mostly in editing. There is far too much repetition and one can see that a considerably tauter and more focused volume would have been possible with better editorial control of the subject matter from the diverse array of contributors. This was particularly evident in the chapters on antibody and immune-based strategies for treatment, where there was much annoying repetition of material. Inevitably, the tyranny of publication deadlines has resulted in omission of late-breaking news: the remarkably high (and durable) complete response rates observed in over 200 previously untreated patients with progressive CLL entered on a Phase II study of combination therapy with Cyclophosphamide, Fludarabine, and Mabthera at the University of Texas at MD Anderson Cancer Centre. This is a finding which is being evaluated in a randomised trial in Europe, but if confirmed will change our mindset about CLL being an essentially incurable illness.
This is not a book for the trainee in oncology, nor for oncologists practising outside of haematological malignancies. It will appeal to haematologists interested in a comprehensive overview of this disease, particularly with the extensive bibliographies provided with all chapters. I will certainly be referring a lot to my copy in future.