{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:49:38Z","timestamp":1792482578322,"version":"4.5.0"},"reference-count":35,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,8,13]],"date-time":"2019-08-13T00:00:00Z","timestamp":1565654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The current study assesses the characteristics and outcomes of multiple myeloma (MM) patients, treated with novel agents for hematogenous extramedullary (HEMM) relapse. Consecutive patients diagnosed with HEMM between 2010\u20102018 were included. Patients' characteristics at diagnosis and at HEMM presentation, response to treatment, survival and factors predicting survival were recorded and analyzed. A group of 127 patients, all diagnosed with HEMM by imaging (87.3%) and\/or biopsy (79%), were included. Of those, 44% were initially diagnosed with ISS3, 57% presented with plasmacytomas, and 30% had high\u2010risk cytogenetics. Median time to HEMM was 32\u2009months. In multivariate analysis, ISS3 and bone plasmacytoma predicted shorter time to HEMM (\n                    <jats:italic>P<\/jats:italic>\n                    = .005 and\n                    <jats:italic>P<\/jats:italic>\n                    = .008, respectively). Upfront autograft was associated with longer time to HEMM (\n                    <jats:italic>P<\/jats:italic>\n                    = .002). At HEMM, 32% of patients had no BM plasmacytosis, 20% had non\u2010secretory disease and 43% had light\u2010chain disease. Multiple HEMM sites were reported in 52% of patients, mostly involving soft tissue, skin (29%), and pleura\/lung (25%). First treatment for HEMM included proteasome inhibitors (50%), immunomodulatory drugs (IMiDs) (39%), monoclonal antibodies (10%), and chemotherapy (53%). Overall response rate (ORR) was 57%. IMiDs were associated with higher ORR (HR 2.2, 95% CI 1.02\u20104.7,\n                    <jats:italic>P<\/jats:italic>\n                    = .04). Median survival from HEMM was 6 months (CI 95% 4.8\u20107.2). Failure to achieve \u2265VGPR was the only significant factor for worse OS in multivariate analyses (HR = 9.87, CI 95% 2.35 \u2010 39,\n                    <jats:italic>P<\/jats:italic>\n                    = .001). In conclusion, HEMM occurs within 3 years of initial myeloma diagnosis and is associated with dismal outcome. The IMiDs might provide a higher response rate, and achievement of \u2265VGPR predicts longer survival.\n                  <\/jats:p>","DOI":"10.1002\/ajh.25579","type":"journal-article","created":{"date-parts":[[2019,7,23]],"date-time":"2019-07-23T10:35:27Z","timestamp":1563878127000},"page":"1132-1140","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Hematogenous extramedullary relapse in multiple myeloma \u2010 a multicenter retrospective study in 127 patients"],"prefix":"10.1002","volume":"94","author":[{"given":"Irit","family":"Avivi","sequence":"first","affiliation":[{"name":"Tel Aviv Medical Center and Sackler Faculty of Medicine  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9061-7287","authenticated-orcid":false,"given":"Yael C.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Tel Aviv Medical Center and Sackler Faculty of Medicine  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Suska","sequence":"additional","affiliation":[{"name":"Department of Hematology Jagiellonian University Medical College  Cracow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamir","family":"Shragai","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation South\u2010Pest Central Hospital, Natl. Inst. Hematol. Infectol  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabor","family":"Mikala","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation South\u2010Pest Central Hospital, Natl. Inst. Hematol. Infectol  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6138-8112","authenticated-orcid":false,"given":"Laurent","family":"Garderet","sequence":"additional","affiliation":[{"name":"Service d'H\u00e9matologie et th\u00e9rapie cellulaire H\u00f4pital Saint Antoine  Paris France"},{"name":"Service d'H\u00e9matologie H\u00f4pital Piti\u00e9 Salp\u00eatri\u00e8re  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gueye M.","family":"Seny","sequence":"additional","affiliation":[{"name":"Service d'H\u00e9matologie et th\u00e9rapie cellulaire H\u00f4pital Saint Antoine  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Glickman","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College  New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Jayabalan","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College  New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Niesvizky","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College  New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Gozzetti","sequence":"additional","affiliation":[{"name":"Le Scotte Hospital  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Wi\u015bniewska\u2010Pi\u0105ty","sequence":"additional","affiliation":[{"name":"Department of Haematology and Bone Marrow Transplantation Silesian Medical University  Katowice Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5626-1750","authenticated-orcid":false,"given":"Anna","family":"Waszczuk\u2010Gajda","sequence":"additional","affiliation":[{"name":"Department 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Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5384-8238","authenticated-orcid":false,"given":"Jakub","family":"Radocha","sequence":"additional","affiliation":[{"name":"4th Department of Medicine \u2013 Haematology Charles University Hospital Hradec Kralove  Hradec Kralove Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vibor","family":"Milunovic","sequence":"additional","affiliation":[{"name":"Division of Hematology Clinical Hospital Merkur  Zagreb Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Davila","sequence":"additional","affiliation":[{"name":"Asistencial de Avila Hospital  \u00c1vila Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Gentile","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology Azienda Ospendaliera of Cosenza  Cosenza 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