The Lymphomas

This new work is designed to be the "Bible" for both clinicians and scientists who deal with lymphoma. World authorities have written extensive, referenced chapters dealing with all aspects of the subject. Packed with useful summary tables and abundant illustrations, all chapters are definitive statements from the experts.

COVERS:

molecular biology

bone marrow transplantation

lymphoma in AIDS

Hodgkins disease

As a "lymphomaniac," I avidly read the new textbook The Lymphomas. I found it to be a well-organized, clearly written, complete presentation of the biology, epidemiology, pathology, clinical presentations, and treatment of the lymphomas. It is up to date and provides an excellent, coherent discussion of the new pathologic classifications.

Nevertheless, there are some disappointments. The title does not inform us that this book encompasses both Hodgkin's disease and the non-Hodgkin's lymphomas. The Lymphomas is aimed at readers with a high level of knowledge and understanding, which is its greatest strength but also a disappointment for interested generalists, medical students, or laypersons, because it assumes that readers have a general knowledge of lymphomas.

The chapters on molecular biology, pathology, and cytogenetics are complete but sometimes redundant. The chapter on immunohistochemistry has five pages of excellent color plates. There are far too many black-and-white photographs throughout the text of pathological processes that have virtually no value to the untutored eye.

The staging of the lymphomas is pivotal to an understanding of the sections on management. This is the weakest component for the uninitiated. Even so, there are wonderful discussions of clinical presentations and imaging. Radiographs are clearly presented, with arrows pointing to abnormalities. The valuable tool of gallium imaging, however, receives only limited discussion.

The chapters on management are uniformly excellent but do suffer slightly from the fact that there are rapid changes in the field. The term "bone marrow transplantation" is used throughout, although most would prefer "stem-cell transplantation" in order to include both bone marrow and peripheral-blood sources of stem cells. The role of stem-cell transplantation during initial treatment is not presented in any detail, although the results of recent prospective clinical trials are compelling. Moreover, the role of the International Lymphoma Study Group's prognostic index in identifying patients with diffuse, large-cell lymphoma at good and poor risk is outlined too briefly.

Mantle-cell lymphoma, which has become increasingly recognized, is unfortunately discussed in the chapter on diffuse, low-grade B-cell lymphomas. Few would consider this disease low grade or indolent in behavior. Follicular lymphomas are discussed cogently and in depth within the context of useful retrospective data from St. Bartholomew's Hospital. The rapidly emerging role of biologic agents and radioimmunotherapy in low-grade lymphomas is addressed only briefly here. The more general chapter on biologic agents is outstanding.

The management of Hodgkin's disease is discussed in several noncontiguous chapters. The role of primary radiation therapy in patients with clinically staged disease (without staging laparotomy) is not fully addressed, which is a disappointment. On the other hand, the technique of radiation therapy is presented in outstanding detail and with excellent illustrations. Combination chemotherapy is discussed in its many facets, but with few specific recommendations. For the generalist, it is difficult to glean, from the objective data presented, how to apply the various chemotherapy regimens, another illustration that this textbook is not meant as a practical compendium for application to treatment.

Despite these deficiencies, it is a pleasure to see so much information on the lymphomas available in an up-to-date and readable format. The authors and editors should be commended for their successful elucidation of these fascinating diseases.

Reviewed by Carol S. Portlock, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.