Book Review:Childhood Leukemias

Childhood Leukemias is a comprehensive text that encompasses every aspect of leukemia in children, ranging from general diagnosis, classification, and pathobiology to management and supportive care. Edited by Ching-Hon Pui, MD, an experienced clinician and director of the Leukemia Division of St. Jude Children’s Research Hospital, the book boasts 43 expert contributors, many of whom are current or former members of the St. Jude faculty.

The handsome volume features clear, easy-to-read type and many high-quality illustrations, including comprehensive tables, diagrams, graphs, and 25 beautiful full-color plates. The chapters are all extensively referenced, most listing 200 to 300 citations each.

Although all of the chapters are of high quality, some deserve special mention. I enjoyed reading the personal historical perspective provided by Donald Pinkel at the beginning of the book. Dr. Pinkel was the first medical director of St. Jude Children’s Research Hospital and is credited with developing the curative approach to children with acute lymphoid leukemia, so-called total therapy, which incorporates effective presymptomatic treatment of the central nervous system. His review of “lessons learned” from the history of leukemia and the development of modern therapy is mandatory reading for any serious student of the subject.

The book contains many chapters reviewing areas of fundamental basic science that are relevant not just to leukemia but also to our general understanding of normal and neoplastic cell growth and differentiation. In-depth discussions of such topics as molecular genetics, cell biology, signal transduction, apoptosis, cellular immunotherapy, and gene transfer enrich the volume and provide a modern context. The association between translational science and leukemia is well covered in several chapters that review such topics as in vitro assays for drug sensitivity, detection of minimal residual leukemia, and applied pharmacokinetics.

Sections on the management of leukemia are logically organized and divided into chapters on acute lymphoblastic leukemia, B-cell acute lymphoblastic leukemia and Burkitt’s lymphoma, acute myeloid leukemia, myelodysplastic syndromes and chronic myeloproliferative disorders, and hematopoietic stem-cell transplantation. It would have been preferable if each of these treatment chapters had been organized along the same general outline; instead, the chapters vary in both organization and quality, with some of the topics (eg, epidemiology, cytogenetics, and immunophenotyping) duplicating material previously presented in other chapters. The chapter on hematopoietic stem-cell transplantation was disappointingly deficient in its discussion of alternative stem-cell sources and unrelated donor transplants. Cord blood transplants scarcely receive a mention.

Notwithstanding these shortcomings, however, this reference volume contains a wealth of information, essentially summarizing all that is known about childhood leukemias, beginning with the first description of leukemia by Virchow 150 years ago. While of great interest and most useful to pediatric hematologists and oncologists, this book would also be helpful to anyone in-terested in the biology or therapy of hematologic malignancies—for which childhood leukemias are the paradigm.