Cambridge University Press, n.p., 2000, 391 pages, hardbound.

Reviewed for Bloodline by:

James R. Mason, M.D. Program Director, Bone and Marrow Transplantation
Scripps Clinic San Diego, California, USA
Aplastic Anemia: Pathophysiology and Treatment
Author(s): H Schrezenmeier and A Bacigalupo
Significant progress has been made in the past several years in understanding the
pathophysiology and causes of aplastic anemia. Likewise, the therapy of aplastic anemia has
evolved as studies of both bone marrow transplantation and immunosuppressant treatments have
been performed and have matured. This book is an effort to provide a concise and up-to-date
summary of the currently established body of information on the pathophysiology and treatment
of aplastic anemia. The editors indicate that the genesis of the book lay within the aplastic
anemia working party of the European Group for Blood and Marrow Transplantation (EBMT).
This book is intended for those who desire a deeper understanding of the pathophysiology of
aplastic anemia and for those needing practical information on the management of patients with
this disorder.
The book is divided into four sections: 1. Pathophysiology of acquired aplastic anemia 2.
Epidemiology and clinical features of acquired aplastic anemia 3. Treatment of acquired aplastic
anemia 4. Fanconi's anemia. Part I, Pathophysiology of acquired aplastic anemia consists of six
chapters, most of which are surprisingly readable. The information provided is up-to-date,
although of little practical value for the practicing hematologist. Part II, "Epidemiology and
clinical features of acquired aplastic anemia" provides a useful background for those unfamiliar
with aplastic anemia, its clinical presentation, and natural history. This section is highly readable
and is appropriate for readers in medical school to those in general practice. Part III, "Treatment
of acquired aplastic anemia" is the book's greatest strength consisting of eight separate chapters
describing the various types of treatment that are possible for aplastic anemia. Information on
supportive care, immunosuppressive treatments, the role of cytokines, and both HLA-identical
sibling and alternative donor bone marrow transplantations are reviewed.
A special chapter is devoted to children with acquired aplastic anemia and there is also a chapter
on clonal transformation. This section ends with a chapter entitled, "Guidelines for treating
aplastic anemia" which is, in fact, a concensus document from a group of international experts.
Overall, this section is quite good with a thorough review of bone marrow transplantation and
immunosuppressive therapy. The guideline section is practical and well written. Disappointingly,
there is little review of an intriguing recent therapy for aplastic anemia using high-dose
cyclophosphamide without stem cell infusion. Moreover, although this text is reasonably up-todate in most sections, some areas are already becoming anachronistic, such as, the advice that
allogeneic peripheral blood stem cells are experimental and should not be used.
The final section is devoted entirely to Fanconi's anemia. This section consists of four chapters
describing: 1) the clinical features and diagnosis of Fanconi's anemia; 2) the genetic basis of
Fancon's anemia; 3) the treatment of Fanconi's anemia; and, 4) the potential genetic correction of
Fanconi's anemia. This part of the book is perhaps slightly less readable than the other sections
on aplastic anemia and, for most practicing hematologists, perhaps less important. Nevertheless,
it is well written and very well balanced in its approach.
Overall, this is a well-written book that provides practical information focused on understanding
aplastic anemia and designing treatment strategies for patients diagnosed with it. Established
therapies, such as immunosuppressive therapy and bone marrow transplantation, are well

reviewed and the practical guidelines for implementing these therapies are clear and
understandable. This is a useful resource book for any practicing hematologist and is highly
recommended for hematologists in training.