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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
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)
E-mail: drrajendrak1@rediffmail.com
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.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
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.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
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
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
Plasmablastic Myeloma- A Diagnostic Dilemma
Correspondence Address :
Dr. MB Deepak,
258/A, Bommasandra Industrial Area, Anekal Taluk, Hosure Road, Bangalore-560099, Karanataka, India.
E-mail: deepak.mb.dr@narayanahealth.org
Plasmablastic neoplasms comprise various haematolymphoid tumours with plasmablastic morphology which includes Plasmablastic Myeloma (PBM) and Plasmablastic Lymphoma (PBL). Distinguishing between these two entities remains a major diagnostic challenge. In view of Epstein Barr Virus (EBV)-Encoded RNA (EBER) negativity, Human Immunodeficiency Virus (HIV) negativity, high Serum Free Light Chain (SFLC) assay and absence of hypermetabolic lymphadenopathy, a final diagnosis of PBM was made. This report is about a 55-year-old lady who presented with fatigue, significant loss of weight, and appetite. She had mild enlargement of the liver, spleen and no significant lymphadenopathy. There were atypical cells in peripheral blood. Bone marrow evaluation showed 51% atypical mononuclear cells. Flow cytometry was negative for acute leukaemia diagnostic markers. Immunohistochemistry (IHC) on the bone marrow biopsy revealed positivity for Cluster of Differentiation (CD) 138, Multiple Myeloma 1 (MUM1) with kappa light chain restriction and negative for EBER. The free light chain showed a kappa:lambda light chain ratio of 28,885 (0.26-1.65). The diagnosis of PBM was made and she was started on a daratumumab-based immunotherapy regimen. She achieved complete remission after induction with Measurable Residual Disease (MRD) <0.01%. She is presently doing well on follow-up with the disease in remission status.
Multiple myeloma, Plasma cell disorders, Plasmablastic lymphoma
A 55-year-old female with no co-morbidities, presented with fatigue and leg pain for six months. She had a history of significant weight loss and loss of appetite. She did not have any significant medical complaints in the past. No significant family history was present. On clinical examination, there was pallor with right axillary lymphadenopathy and mild hepatosplenomegaly. Systemic examination of other systems was normal. On initial evaluation, the peripheral smear showed dimorphic anaemia and thrombocytopenia with 10% atypical cells (suspected blasts). Her metabolic parameters were within normal limits (Table/Fig 1). She was initially suspected to have acute leukaemia. Bone marrow aspiration and biopsy revealed hypercellular marrow with 51% atypical mononuclear cells (Table/Fig 2),(Table/Fig 3).
Flow cytometry for atypical cells was negative for CD markers CD 34, CD 10, CD 19, CD 20, cytoplasmic CD 3, CD 4, CD 5, CD 7, CD 33, CD 117, Human Leukocyte Antigen-DR (HLA-DR) isotype, cytoplasmic Myeloperoxidase (cMPO) and TdT. CD 38 was dim positive and CD 200 was bright positive. Hence, acute leukaemia was ruled out. Immunohistochemistry (IHC) on bone marrow biopsy revealed sheets of tumour cells, positive for CD 138 (Table/Fig 4) and MUM1 (Table/Fig 5) with kappa light chain restriction (Table/Fig 6) and lambda negative (Table/Fig 7). Tumour cells were negative for CD 20, CD 56, CD 117, E-cadherin, cyclin D1, ALK, and EMA with a Ki-67 index of 60 to 70%. Atypical cells were negative for EBER. Differential diagnosis of PBM and PBL was considered and evaluated further. Her serum immunofixation electrophoresis showed free kappa paraproteinemia and the free light chain assay showed a free kappa chain of 1580 mg/L and free lambda chain of 0.054 mg/L with a kappa: lambda light chain ratio of 28885 (0.26-1.65). Beta-2 microglobulin level was high at 3.03 mg/dL (0.8-2.19). Chromosomal analysis showed a normal karyotype (46 XX). The Fluorescence In-Situ Hybridisation (FISH) Panel revealed 1p32.3 deletion, 14q32.33 deletion, and 1q21 amplification. Positron Emission Tomography (PET) did not show any fluorodeoxyglucose (FDG) avid lesions or lytic bony lesions and her HIV test was negative. Hence, the final diagnosis of PBM was made considering the overall clinical and laboratory results.
She was started on daratumumab, bortezomib, and dexamethasone therapy in view of high risk as per mSMART (Mayo Stratification for Myeloma and Risk adapted Therapy) classification (1). After induction therapy (eight weekly injections), MRD by flow cytometry was negative (<0.01%). Following induction, she received consolidation with the same regimen once in two weeks for four more doses. Her free light chain ratio was normal (1.212). She received two further doses of maintenance of daratumumab therapy with intervals of one month between. Due to the COVID-19 pandemic, autologous cells were collected and cryopreserved with a plan to perform autologous transplantation at a later date.
She is on follow-up presently two years post-therapy with the latest free light chain assay showing a mild increase in kappa: lambda ratio of 27.194 with other blood parameters in the normal range. She did not want to undergo autologous transplantation presently, hence, she has been advised to follow-up every three months to monitor for any further progression of the disease.
Multiple Myeloma (MM) accounts for 1% of all malignancies and 10% of haematological malignancies (2). Plasmablastic morphology is seen in approximately 10% of newly diagnosed myeloma patients (3). It is a very rare and aggressive MM subtype, associated with an overall poor prognosis and survival [4,5]. The initial presentation can also be confused with acute leukaemia if there are circulating atypical blastoid cells in the peripheral blood (6). Another frequent problem faced by clinician and pathologist is distinguishing it from PBL which is defined as a variant of Diffuse Large B-Cell Lymphoma (DLBCL). PBL is frequently associated with extramedullary disease, HIV and EBV positivity (7).
In the present case, the patient presented with isolated medullary disease and was negative for both HIV and EBV viruses. The distinction between PBM and PBL is often difficult, especially in EBV-negative tumours in immunocompetent adults. A combination of morphological, phenotypical and selected clinical findings can help in differentiating PBM from PBL. PBM and PBL are terminally differentiated plasma cells (B-cells) and are positive for CD138 and MUM-1, while negative for CD20 and PAX-5 (8),(9).
A study by Vega F et al., found that the only significant difference between PBL and plasma cell myeloma was the presence of EBER, which was positive in all PBL cases tested and negative in all plasma cell myelomas (10). In yet another study by Ahn JS et al., again the most useful histopathological parameter was a positive EBV in situ hybridisation (11). Other factors such as associated lymphadenopathy and/or oral mass in the absence of complete myeloma-defining signs were used to favour a diagnosis of lymphoma (11). Ki-67 may not help in distinguishing PBM from PML as both entities usually demonstrate high rates of proliferation (10).
In the present case, because of EBER negativity, high SFLC assay and absence of hypermetabolic lymphadenopathy a final diagnosis of PBM was made. In a post-transplant lymphoproliferative disorder case reported by Ramadas P et al., the authors highlight the diagnostic dilemma to differentiate between PBM and PBL (12). Presence of a paraprotein with lambda restriction, lytic lesion and negativity for EBER supported PBM. Such case reports highlight the importance of multimodality diagnostic methods including clinical, radiological, morphological and immunophenotypic features to distinguish between these two conditions.
PBM is treated with various combinations of steroids, proteasome inhibitors, immunomodulatory agents, and alkylators while PBLs have been treated with lymphoma-based regimens such as cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine (hyper CVAD), infusional etoposide, vincristine and doxorubicin with bolus cyclophosphamide and prednisone (EPOCH) (13).
The index patient here was treated with a triple-drug regimen of daratumumab (anti-CD38 antibody), bortezomib, and dexamethasone combination therapy considering the high-risk nature of the disease. She achieved stringent Complete Response (sCR) and was counselled for autologous transplantation. High-dose therapy followed by autologous rescue is routinely considered in all eligible patients with PBM though the plasmablastic variant has been associated with poor prognosis even after autologous transplantation (14). In a case report by Suarez-Londono JA et al., aggressive PBM with spinal cord involvement was treated with radiation and systemic treatment with a combination of daratumumab along with cyclophosphamide, doxorubicin, vincristine, and prednisone every three weeks, which resulted in partial response after three cycles (15). Unfortunately, he decompensated due to severe sepsis secondary to pneumonia, leading to respiratory failure and death.
The outcomes of PBM have been traditionally very poor with a median survival of 1.9 years (5). The newer drugs in the pipeline have the potential to increase the event free-and median survival rates. Daratumumab is a newer IgG1κ human monoclonal antibody against CD38 and inhibits the growth of tumour cells by inducing apoptosis. Daratumumab has been well studied in MM and is being used in newly diagnosed high-risk myeloma and relapsed/refractory myeloma (1). As PBM and PBL express the CD38 marker there is interest in using this drug in these diseases though the experience has been limited to case reports. There are multiple case reports of daratumumab-based regimens in PBL and PBM with good results (16),(17),(18),(19).
The PBM is a diagnostic dilemma with overlapping clinical, morphological, and immunophenotypic features with that of PBL. It is often difficult to distinguish between these two entities but some clues such as EBV negativity, HIV negativity, high serum-free light chains, and lack of lymphadenopathy may swing the pendulum towards PBM diagnosis.
DOI: 10.7860/JCDR/2023/55807.17936
Date of Submission: May 01, 2022
Date of Peer Review: Jul 05, 2022
Date of Acceptance: Feb 13, 2023
Date of Publishing: May 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 04, 2022
• Manual Googling: Jan 05, 2023
• iThenticate Software: Jan 20, 2023 (4%)
ETYMOLOGY: Author Origin
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