Hematopoietic Growth Factors in Clinical Applications

A minor criticism of the book, is that few of the practical protocols quoted seem to have been improved by application in the authors' own laboratory. If one uses a technique regularly, it is usual to come up with little ways of improving the method. In this book, most of the protocols seem to be copied unchanged from the original source. For example, in protocol 3.11 on performing DNA measurements from paraffin embedded material, the authors suggest the use of 30 ym sections, whilst it has been recognised for some time, that this is not the optimum and that 50 m sections often give significantly better results. Further, many laboratories have automated this technique, to make it quicker and more convenient to perform. Although I have used Chapter 3 as an example, my impression is that these criticisms apply throughout the book. Undoubtedly, this book contains useful information but the market for flow cytometry books is becoming more competitive. From the middle of 1990 to mid-1992, at least eight flow cytometry books have, or are scheduled to, appear on the market. Thus, any new book needs to have a clear objective and to be well written and organised. In my view, this book tends to fall between stools in its aims, and could have benefited from a better level of organisation. Given the availability of alternative books, I would find it hard to recommend this book to new colleagues or students. Since the first haemopoietic growth factors became available for clinical testing over 5 years ago, there has been a rapid expansion in the literature. The two editors Roland Mertels-mann and Friedhelm Herrmann of this multi-author text, have made major contributions to this field. They have invited contributors to initially address the biology and basic concepts of haemopoietic growth factors before embarking on clincial applications. As might be expected with over 75 authors, there is some repetition and the standard of contribution varies. The pre-clinical chapters give a good review of the cytokines available for testing, their production, mechanism of action, and receptor expression. The book then naturally progresses to the studies in subhuman primates before coming through to man. The clinical data are predominantly from Phase I and II trials of Granulocyte and Granulocyte-Macrophage Colony Stimulating Factors, although data are presented on Erythropoietin and Interleukin-3. This section deals mainly with reduction in the period of neutropenia after chemo-therapy or …

A minor criticism of the book, is that few of the practical protocols quoted seem to have been improved by application in the authors' own laboratory. If one uses a technique regularly, it is usual to come up with little ways of improving the method. In this book, most of the protocols seem to be copied unchanged from the original source. For example, in protocol 3.11 on performing DNA measurements from paraffin-embedded material, the authors suggest the use of 30 ym sections, whilst it has been recognised for some time, that this is not the optimum and that 50 m sections often give significantly better results. Further, many laboratories have automated this technique, to make it quicker and more convenient to perform.
Although I have used Chapter 3 as an example, my impression is that these criticisms apply throughout the book. Undoubtedly, this book contains useful information but the market for flow cytometry books is becoming more competitive. From the middle of 1990 to mid-1992, at least eight flow cytometry books have, or are scheduled to, appear on the market. Thus, any new book needs to have a clear objective and to be well written and organised. In my view, this book tends to fall between stools in its aims, and could have benefited from a better level of organisation. Given the availability of alternative books, I would find it hard to recommend this book to new colleagues or students.
Since the first haemopoietic growth factors became available for clinical testing over 5 years ago, there has been a rapid expansion in the literature. The two editors Roland Mertelsmann and Friedhelm Herrmann of this multi-author text, have made major contributions to this field. They have invited contributors to initially address the biology and basic concepts of haemopoietic growth factors before embarking on clincial applications.
As might be expected with over 75 authors, there is some repetition and the standard of contribution varies. The preclinical chapters give a good review of the cytokines available for testing, their production, mechanism of action, and receptor expression. The book then naturally progresses to the studies in sub-human primates before coming through to man. The clinical data are predominantly from Phase I and II trials of Granulocyte and Granulocyte-Macrophage Colony Stimulating Factors, although data are presented on Erythropoietin and Interleukin-3. This section deals mainly with reduction in the period of neutropenia after chemotherapy or bone marrow transplantation, but there are also chapters on myelodysplasia and aplastic anaemia. There is an interesting section on the effect of colony stimulating factors on malignant cells. This concentrates predominantly on the potentially advantageous use of these agents to recruit myeloid leukaemic cells into cycle prior to chemotherapy. The book concludes with pre-clinical data on Interleukin 4 and 6 which have just entered clinical trials. It may be slightly too early to give firm recommendation for the clinical indication for the use of haemopoietic growth factors, but I felt that an attempt should have been made to have a chapter in which the clinical data presented were critically evaluated. Now that these agents are being marketed, I suspect that clinicians having read the title of this book would have expected more guidance and help on the best way to utilise these powerful agents in the most cost beneficial manner for their patients. With the plethora of talent and experience available from the authors contributing to this book, it should have been possible to entice one of them to have written this finale.
A review at this time can only be a 'snapshot' of this rapidly progressing field. Readers will, however, find that this review will give them an excellent basis of knowledge critically to evaluate publications as they appear. It will appeal predominantly to clinicians wishing to rapidly assimilate the basic science as well as the clinical results. the art on screening for that particular cancer including a list of recommendations for research. This is followed by a number of chapters from different authors' presentations at the workshop and finally an edited summary of the discussion. The book is clearly laid out for reference purposes and presents the concepts of screening straightforwardly. The Editors state, in their Preface, that the book is targeted at those 'interested in screening for cancer including government and non-government organisations concerned with cancer control' and cancer researchers. Experts in cancerscreening may find the book rather too simple but it is pitched at the right level for the non-expert. Those hoping that the book will summarise the results of all the various studies to date will be disappointed; in Chapter 1 on the UK Trial, for example, the discussion is mainly concerned with sensitivity, specificity and biopsy rates.
The first section on breast cancer contains five chapters each on one of the well-known trials of screeningthe UK trial, the trials from Finland, the Swedish 2-County trial, the Malmo trial and that from Canada. Different aspects of these studies are described and some of the puzzling differences in results discussed. A sixth chapter on breast self-examination (BSE) as a strategy for downstaging in developing countries and the importance, and feasibility, of giving adequate treatment without major technological investment is unfortunately too early to give any results of the USSR/Germany/WHO trial. A clearly presented account of the principles involved in different types of cost-effectiveness analysis completes this section.
The section on cervical screening includes chapters on natural history, a description of the screening programmes in the Nordic countries indicating the stark contrast between the success of the best-organised programmes there to the relative lack of success of the programmes in Canada, and indeed in the UK. The importance of 'political will' in ensuring the success of national programmes and the difficulties of reducing the overscreening of low-risk groups are rightly emphasised. Chapter 18 contains an excellent discussion of the evidence for the effect of timing of referral for colposcopy in terms of degree of dysplasia. While the first four chapters in the section consider cervical screening in developing countries where as few as 5% of women may have been screened within the previous 5 years. The enormous problems of setting up and evaluating even the simplest of organised programmes (which have in the past at least, defeated evensome developed countries) are discussed. This surely must be a major challenge for preventative medicine in the next decade.
Sections 1 and 3 thus discuss two cancer sites where there is sufficient evidence of the potential or actual advantages of