Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
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Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 559 - 560

Myeloma in the Young


Department of Pathology, Kasturba Medical College Mangalore, Karnataka, India

Correspondence Address :
Dr Garima Goel, MBBS, MD
Assistant Professor, Department of Pathology
Kasturba Medical College, Light house Hill Road, Mangalore
Karnataka 575001, India
Email:; Phone: +919650333630


Introduction: Multiple myeloma (MM) is a neoplastic plasma cell proliferation involving the bone marrow and extraosseous tissues which usually occurs in the elderly, (aged, 60 to 70 years), while patients younger than 30 or 40 years account for only 0.3 and 2.2 %,of all myelomas, respectively.

Materials and Methods: The present study analyzed 7 patients younger than 40 years among 87 patients of MM who presentedto our hospital from 2005 to 2008. Complete diagnostic workup was carried out for all the patients.

Results: The youngest of the 7 patients included in the study was a 30 year old female. All the patients had marrow involvement by neoplastic plasma cells.

Conclusion: The survival of patients younger than 40years with MM is longer than observed in other series of patients of all ages with MM.


Multiple myeloma, Young adults, Survival

Multiple myeloma (MM) is a malignant disorder of the plasma cells that accounts for about 1% of all the malignant disorders (1). MM is a disease of the elderly, with a peak age incidence between 60-70 years. The occurrence of MM in patients who are younger than 40 years is rare, the frequency being only 2.2% (1), (2). Adolescents and very young adults may have a atypical clinical presentation and an indolent course with prolonged survival (3). In this study, we have analyzed the characteristics of 7 patients who were younger than 40 years, with MM, from a single institution. The purpose of this study was to describe the presenting clinical and laboratory features and to analyze the response to therapy and survival in patients with MM, who were younger than 40 years.

Material and Methods

We analyzed 7 patients of MM who were younger than 40 years among 87 patients of multiple myeloma, who presented to our hospital from 2005 to 2008. A complete diagnostic workup was carried out for all the patients. The diagnosis of MM was based on the Salmon and Durie criteria (4).


Seven patients who were younger than 40 years were reviewed from 87 cases of multiple myeloma, who were diagnosed at ourhospital from 2005 to 2008. The youngest of these was a 30 year old female. The clinical and laboratory data of our 7 patients is given in (Table/Fig 1) and (Table/Fig 2). All the patients had marrow involvement by neoplastic plasma cells. The major criteria (>30%) was fulfilled in 5 patients and the minor criteria (10-30%) in 2 patients. All the patients showed the ‘M’ band in the serum electrophoresis, except for case 2. However, none of the patients showed Bence Jones proteins in the urine. Five of the 7 patients presented with a history of backache, one patient with generalized weakness and one with bony tenderness over the anterior chest wall. Two of the 7 patients had impaired renal function (creatinine ≥ 2 mg/dl) and 5 had a haemoglobin level which was less than 11gm% at diagnosis. All patients had radiological involvement in the form of lytic lesions in the bone, except for case 4, which showed only osteoporotic changes, whereas case 5 showed the presence of pathological fractures along with the lytic lesions. Five patients had stage II (A, 4 patients: B, one patient) and the remainder had stage III (both A) disease. Three out of 7 patients developed extramedullary plasmacytoma during the course of the disease.

All, but 2 of the 7 patients were treated with a combination chemotherapy regimen of VAD (Vincristine, Adriamycin and High dose Dexamethasone). Two patients were lost to follow up before the initiation of therapy. At the time of the analysis, two of the sevenpatients (Cases 1 and 2) had died, 3 were alive with a median survival of 38 months and the remaining 2 patients were lost to follow up.


MM is a malignant disorder which is characterized by the proliferation of monoclonal plasma cells.(1),(3) The peak incidence of MM is in the seventh decade, whereas, it is a rare entity in young patients, with less than 2% cases occurring in patients under the age of 40 years and it is still rarer in patients who are younger than 30 years (1), (5). A study of 3815 cases of MM by the National Cancer Institute showed that the frequency of such an occurrence was 7/3815 ie; 0.18%.6 Whereas, Hewell et al in their study, have reported the frequency to be 1%.7 In our study, the frequency of MM in patients who were younger than 40 years was found to be 8%. The increased frequency might be due to a smaller sample size as compared to that of other studies.

In various studies which were done in the past, the presenting clinical and laboratory features such as bone pain, weakness and fatigue and infection were similar to those which were observed in older patients (6). Renal function impairment is a well known complication of MM. A Mayo clinic analysis revealed renal function impairment and hypercalcaemia in 30% and 20% of the patients, respectively (3). In our subjects however, there was no evidence of hypercalcaemia, but 2 out of 7 patients (14%) showed renal impairment.

Various studies which were done in the past, suggested the association of the extramedullary component in most of these patients. Blade et al and Geetha et al in their respective studies, described the increased association of extramedullary plasmacytoma with bone marrow plasmacytosis in patients of MM who were younger than 40 years (2),(6). In our study, 3 out of 7 cases developed extramedullary plasmacytomas during the course of the disease.

The treatment for young patients with multiple myeloma was similar to that which was used for the elderly patients. The literature shows that both radiotherapy and chemotherapy have been used for the management of such patients (1).

The median duration of survival of the patients with MM in all the age groups usually ranges between 2-3 years.3 Blade et al, in their study on 72 patients, found that the median survival was 54 months in younger patients with MM, which was clearly longer than that which was usually seen in patients with MM (6)(7)(8). In our study, out of the 4 patients for whom the follow up was available, 2 were found to be alive and responding well to combination chemotherapy at the time of analysis. The median survival was found to be 38 months in the present study. Thus, the occurrence of myeloma in younger individuals does not appear to impart a worse prognosis or survival.


The presenting clinical and laboratory features and the response to therapy by patients who were younger than 40 years with MM, are similar to those which are observed in other myeloma series. However, the survival of such patients is longer than that which is observed in other series of patients of all ages with MM. Therefore, we can presume that age does have some beneficial effect on the natural history and the course of the disease.


Kapoor R, Bansal M, Sastri GJ, Sandhu MS, Garg M et al. Clinical spectrum and prognosis of multiple myeloma in patients younger than 30 years: Is it different from elderly? JK Science 2006; 8(4): 225-28.
Geetha N, Jayaprakash M, Rekhanair A, Ramachandran K, Rajan B. Plasma cell neoplasms in the young. Br J Radiol 1999; 72(862): 1012-15.
Blade J, Kyle RA, Greipp PR. Multiple myeloma in patients younger than 30 years: Report of 10 cases and review of literature. Arch Intern Med 1996; 156: 1463-68.
Durie BGM, Salmon SE. Multiple myeloma, macroglobulinemia and monoclonal gammopathies. In : Hofbrand AV, Brain MC, Hirsh J. (eds). Recent Advances in Haematology. Churchill-Livingstone, Edinbrugh. 1977, 243.
Ishida T, Dorfman HD. Plasma cell myeloma in unusually young patients: a report of two cases and review of literature. Skeletal Radiol 1995; 24: 47-51.
Blade J, Kyle RA, Greipp PR. Presenting features and prognosis in 72 patients with multiple myeloma who were younger than 40 years. Br J Hematol 1996; 93: 345-51.
Hewell GM, Alexanian R. Multiple myeloma in young persons. Ann Intern Med 1976; 84: 441-43.
Ludwig H, Durie BG, Bolejack V, Turesson I, Kyle RA, Blade J et al. Myeloma in patients younger than age 50 years presents with more favorable features and shows better survival: an analysis of 10 549 patients from the International Myeloma Working Group. Blood 2008; 111: 4039-47.

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