{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:40:23Z","timestamp":1790091623071,"version":"4.0.1"},"reference-count":39,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T00:00:00Z","timestamp":1724803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81930005"],"award-info":[{"award-number":["81930005"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270232"],"award-info":[{"award-number":["82270232"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82350102"],"award-info":[{"award-number":["82350102"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Relapsed\/refractory multiple myeloma patients with extramedullary disease (EMD) have unfavorable prognosis and lack effective therapy. Chimeric antigen receptor (CAR) T\u2010cell activities in EMD have yet to be determined; how EMD\u2010specific microenvironment influences the clinical outcomes of CAR T\u2010cell therapy remains of great interest. In this prospective cohort study, patients with histologically confirmed extra\u2010osseous EMD were enrolled and treated with combined anti\u2010BCMA and anti\u2010CD19 CAR T\u2010cell therapy from May 2017 to September 2023. Thirty\u2010one patients were included in the study. Overall response occurred in 90.3% of medullary disease and 64.5% of EMD (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009.031). Discrepancies in treatment response were noted between medullary and extramedullary diseases, with EMD exhibiting suboptimal and delayed response, as well as shortened response duration. With a median follow\u2010up of 25.3\u2009months, the median progression\u2010free and overall survival were 5.0 and 9.7\u2009months, respectively. Landmark analysis demonstrated that progression within 6\u2009months post\u2010infusion is strongly associated with an increased risk of death (HR\u2009=\u20094.58;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009.029). Compared with non\u2010EMD patients, patients with EMD showed inferior survival outcomes. Unique CAR\u2010associated local toxicities at EMD were seen in 22.6% patients and correlated with the occurrence and severity of systemic cytokine release syndrome. To the cutoff date, 65% treated patients experienced EMD progression, primarily in the form of BCMA\n                    <jats:sup>+<\/jats:sup>\n                    progression. The pretherapy EMD immunosuppressive microenvironment, characterized by infiltration of exhausted CD8\n                    <jats:sup>+<\/jats:sup>\n                    T cells, was associated with inferior clinical outcomes. CAR T cells have therapeutic activity in relapsed\/refractory EMD, but the long\u2010term survival benefits may be limited. EMD\u2010specific microenvironment potentially impacts treatment. Further efforts are needed to extend EMD remission and improve long\u2010term outcomes.\n                  <\/jats:p>","DOI":"10.1002\/ajh.27469","type":"journal-article","created":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T09:36:18Z","timestamp":1724837778000},"page":"2286-2295","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Clinical outcomes and microenvironment profiling in relapsed\/refractory multiple myeloma patients with extramedullary disease receiving anti\u2010\n                    <scp>BCMA CAR<\/scp>\n                    T\u2010cell\u2010based therapy"],"prefix":"10.1002","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4431-3060","authenticated-orcid":false,"given":"Yuekun","family":"Qi","sequence":"first","affiliation":[{"name":"Blood Diseases Institute Cancer Institute Xuzhou Medical University  Xuzhou China"},{"name":"Department of Hematology The Affiliated Hospital of Xuzhou Medical University  Xuzhou China"},{"name":"Jiangsu Key Laboratory of Bone Marrow Stem Cells  Xuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hujun","family":"Li","sequence":"additional","affiliation":[{"name":"Blood Diseases Institute Cancer Institute Xuzhou Medical University  Xuzhou China"},{"name":"Department of Hematology The Affiliated Hospital of Xuzhou Medical University  Xuzhou China"},{"name":"Jiangsu Key Laboratory of Bone Marrow Stem Cells  Xuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunming","family":"Qi","sequence":"additional","affiliation":[{"name":"Blood Diseases Institute Cancer Institute Xuzhou Medical University  Xuzhou China"},{"name":"Department of Hematology The Affiliated Hospital of Xuzhou Medical University  Xuzhou China"},{"name":"Jiangsu Key Laboratory of Bone Marrow Stem Cells  Xuzhou 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