Haematological Oncology: Clinical Practice - Tapa dura

The purpose of this book is to offer, in reasonably short compass, an account of the clinical management of malignant blood disorders, and to review the development of present understanding of the cytobiology of these diseases, on which diagnostic and therapeutic practice is based. The last two decades have witnessed a remarkably rapid accumulation of knowledge in the biological field, with the use of modern scientific technology, including cytochemical and ultrastructural expansions of orthodox cytology; immunocytochemical and immunohistochemical application of cell and surface membrane antigen analysis, with particular benefit from the monoclonal antibody revolution; the development of effective banding methods for chromosomal identification and description, and further techniques for high resolution banding; the localization of viral and cellular oncogenes by in situ hybridisation of specific probes; and the cloning and expression of genes of biologically active substances such as interferons and interleukins. Increasing knowledge of cell dynamics and movements through the mitotic cycle in malignant cell populations, using autoradiography or flow cytometry, have helped in the design of new therapeutic approaches, less dependant on empirical trials than in the past. All these techniques, including the relevant methods of molecular biology, and the salient results pertinent to clinical practice, are broadly reviewed in chapter 1. The general and more detailed principles of therapeutic practice, including the nature, mechanisms of action and use of cytotoxic agents, the practical management of infectious and cytopenic complications and the use of supportive care, the techniques and value of allogeneic or autologous bone marrow transplantation or peripheral stem cell rescue after intensive cytotoxic therapy, and the potential place of biological response modifiers and other new approaches are reivewed in chapter 2. The remaining six chapters deal respectively with acute leukaemias, chronic myeloproliferative states, chronic lymphoproliferative states, multiple myeloma and other differentiated B-cell malignancies, Hodgkin's disease, and non-Hodgkin's lymphomas. In each case the history, the development of classification, the incidence, aetiology and pathogenesis, and clinical aspects of onset, diagnosis, staging where appropriate, treatment, and course and prognosis are dealt with in sequence. In dealing with therapy particular emphasis is given to the large scale, multicentre trials which offer the best prospect of providing valid comparisons between competing protocols. With many of these we are especially familiar as they have been conducted in the UK or Italy. Throughout the book the authors have set out to integrate the clinical aspects and therapeutic approaches with the biological and functional concepts necessary for their understanding. At the same time, the intention has been to bridge the gap between the shorter textbooks of medicine or geneal haematology, which tend to devote a relatively restricted space to malignant blood disorders, and the more highly specialized and extensively referenced monographs on individual malignant diseases, often with multiple authorship. The former may be appropriate for the less adventurous undergraduate, and the latter for specialists and research workers - it is hoped that postgraduates training in clinical haematology or clinical oncology, as well s practising clinicians, may find this intermediate approach rewarding.