{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:05:44Z","timestamp":1792652744271,"version":"4.5.0"},"reference-count":63,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:00:00Z","timestamp":1632873600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:00:00Z","timestamp":1632873600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Blood Cancer J."],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>When clonal plasma cells grow at anatomic sites distant from the bone marrow or grows contiguous from osseous lesions that break through the cortical bone, it is referred to as extramedullary multiple myeloma (EMD). EMD remains challenging from a therapeutic and biological perspective. The pathogenetic mechanisms are not completely understood and it is generally associated with high-risk cytogenetics which portends poor outcomes. There is a rising incidence of EMD in the era of novel agents, likely a reflection of longer OS, with no standard treatment approach. Patients benefit from aggressive chemotherapy-based approaches, but the OS and prognosis remains poor. RT has been used for palliative care. There is a need for large prospective trials for development of treatment approaches for treatment of EMD.<\/jats:p>","DOI":"10.1038\/s41408-021-00527-y","type":"journal-article","created":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T06:15:16Z","timestamp":1632896116000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":129,"title":["Extramedullary disease in multiple myeloma"],"prefix":"10.1038","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0964-098X","authenticated-orcid":false,"given":"Radhika","family":"Bansal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagar","family":"Rakshit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5392-9284","authenticated-orcid":false,"given":"Shaji","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,29]]},"reference":[{"key":"527_CR1","doi-asserted-by":"publisher","first-page":"e538","DOI":"10.1016\/S1470-2045(14)70442-5","volume":"15","author":"SV Rajkumar","year":"2014","unstructured":"Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15:e538\u201348.","journal-title":"Lancet Oncol"},{"key":"527_CR2","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1111\/bjh.12223","volume":"161","author":"L Billecke","year":"2013","unstructured":"Billecke L, Murga Penas EM, May AM, Engelhardt M, Nagler A, Leiba M, et al. Cytogenetics of extramedullary manifestations in multiple myeloma. Br J Haematol. 2013;161:87\u201394.","journal-title":"Br J Haematol"},{"key":"527_CR3","doi-asserted-by":"publisher","first-page":"360","DOI":"10.3324\/haematol.2013.094409","volume":"99","author":"L Pour","year":"2014","unstructured":"Pour L, Sevcikova S, Greslikova H, Kupska R, Majkova P, Zahradova L, et al. Soft-tissue extramedullary multiple myeloma prognosis is significantly worse in comparison to bone-related extramedullary relapse. Haematologica. 2014;99:360\u20134.","journal-title":"Haematologica"},{"key":"527_CR4","doi-asserted-by":"publisher","first-page":"3805","DOI":"10.1200\/JCO.2011.34.9290","volume":"29","author":"J Blad\u00e9","year":"2011","unstructured":"Blad\u00e9 J, Fern\u00e1ndez de Larrea C, Rosi\u00f1ol L, Cibeira MT, Jim\u00e9nez R, Powles R. Soft-tissue plasmacytomas in multiple myeloma: incidence, mechanisms of extramedullary spread, and treatment approach. J Clin Oncol. 2011;29:3805\u201312.","journal-title":"J Clin Oncol"},{"key":"527_CR5","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1038\/leu.2012.336","volume":"27","author":"C Fern\u00e1ndez de Larrea","year":"2013","unstructured":"Fern\u00e1ndez de Larrea C, Kyle RA, Durie BGM, Ludwig H, Usmani S, Vesole DH, et al. Plasma cell leukemia: consensus statement on diagnostic requirements, response criteria and treatment recommendations by the International Myeloma Working Group. Leukemia. 2013;27:780\u201391.","journal-title":"Leukemia"},{"key":"527_CR6","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1016\/j.clml.2014.12.013","volume":"15","author":"S Deng","year":"2015","unstructured":"Deng S, Xu Y, An G, Sui W, Zou D, Zhao Y, et al. Features of extramedullary disease of multiple myeloma: high frequency of p53 deletion and poor survival: a retrospective single-center study of 834 cases. Clin Lymphoma Myeloma Leuk. 2015;15:286\u201391.","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"527_CR7","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1038\/leu.2011.29","volume":"25","author":"KD Short","year":"2011","unstructured":"Short KD, Rajkumar SV, Larson D, Buadi F, Hayman S, Dispenzieri A, et al. Incidence of extramedullary disease in patients with multiple myeloma in the era of novel therapy, and the activity of pomalidomide on extramedullary myeloma. Leukemia. 2011;25:906\u20138.","journal-title":"Leukemia"},{"key":"527_CR8","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1093\/annonc\/mdp329","volume":"21","author":"M Varettoni","year":"2009","unstructured":"Varettoni M, Corso A, Pica G, Mangiacavalli S, Pascutto C, Lazzarino M. Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients. Ann Oncol. 2009;21:325\u201330.","journal-title":"Ann Oncol"},{"key":"527_CR9","doi-asserted-by":"publisher","first-page":"890","DOI":"10.3324\/haematol.2017.178434","volume":"103","author":"N Gagelmann","year":"2018","unstructured":"Gagelmann N, Eikema DJ, Iacobelli S, Koster L, Nahi H, Stoppa AM, et al. Impact of extramedullary disease in patients with newly diagnosed multiple myeloma undergoing autologous stem cell transplantation: a study from the Chronic Malignancies Working Party of the EBMT. Haematologica. 2018;103:890\u20137.","journal-title":"Haematologica"},{"key":"527_CR10","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.3324\/haematol.2012.065698","volume":"97","author":"SZ Usmani","year":"2012","unstructured":"Usmani SZ, Heuck C, Mitchell A, Szymonifka J, Nair B, Hoering A, et al. Extramedullary disease portends poor prognosis in multiple myeloma and is over-represented in high-risk disease even in the era of novel agents. Haematologica. 2012;97:1761\u20137.","journal-title":"Haematologica"},{"key":"527_CR11","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1007\/s00277-016-2847-z","volume":"96","author":"S Mangiacavalli","year":"2017","unstructured":"Mangiacavalli S, Pompa A, Ferretti V, Klersy C, Cocito F, Varettoni M, et al. The possible role of burden of therapy on the risk of myeloma extramedullary spread. Ann Hematol. 2017;96:73\u201380.","journal-title":"Ann Hematol"},{"key":"527_CR12","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1038\/sj.bmt.1702659","volume":"26","author":"G Chong","year":"2000","unstructured":"Chong G, Byrnes G, Szer J, Grigg A. Extramedullary relapse after allogeneic bone marrow transplantation for haematological malignancy. Bone Marrow Transplant. 2000;26:1011\u20135.","journal-title":"Bone Marrow Transplant"},{"key":"527_CR13","doi-asserted-by":"publisher","first-page":"2708","DOI":"10.1182\/blood-2006-07-035857","volume":"109","author":"Y Alsayed","year":"2007","unstructured":"Alsayed Y, Ngo H, Runnels J, Leleu X, Singha UK, Pitsillides CM, et al. Mechanisms of regulation of CXCR4\/SDF-1 (CXCL12)-dependent migration and homing in multiple myeloma. Blood. 2007;109:2708\u201317.","journal-title":"Blood"},{"key":"527_CR14","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1096\/fj.06-6610com","volume":"21","author":"T Tohami","year":"2007","unstructured":"Tohami T, Drucker L, Shapiro H, Radnay J, Lishner M. Overexpression of tetraspanins affects multiple myeloma cell survival and invasive potential. FASEB J. 2007;21:691\u20139.","journal-title":"FASEB J"},{"key":"527_CR15","doi-asserted-by":"publisher","first-page":"5782","DOI":"10.1182\/blood-2011-09-380410","volume":"119","author":"AK Azab","year":"2012","unstructured":"Azab AK, Hu J, Quang P, Azab F, Pitsillides C, Awwad R, et al. Hypoxia promotes dissemination of multiple myeloma through acquisition of epithelial to mesenchymal transition-like features. Blood. 2012;119:5782\u201394.","journal-title":"Blood"},{"key":"527_CR16","doi-asserted-by":"publisher","DOI":"10.1038\/oncsis.2016.5","volume":"5","author":"O Jung","year":"2016","unstructured":"Jung O, Trapp-Stamborski V, Purushothaman A, Jin H, Wang H, Sanderson RD, et al. Heparanase-induced shedding of syndecan-1\/CD138 in myeloma and endothelial cells activates VEGFR2 and an invasive phenotype: prevention by novel synstatins. Oncogenesis. 2016;5:e202.","journal-title":"Oncogenesis"},{"key":"527_CR17","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1111\/j.1365-2141.2009.08009.x","volume":"148","author":"YW Qiang","year":"2010","unstructured":"Qiang YW, Chen Y, Brown N, Hu B, Epstein J, Barlogie B, et al. Characterization of Wnt\/\u03b2\u2010catenin signalling in osteoclasts in multiple myeloma. Br J Haematol. 2010;148:726\u201338.","journal-title":"Br J Haematol"},{"key":"527_CR18","doi-asserted-by":"publisher","first-page":"257","DOI":"10.3233\/CBM-160158","volume":"18","author":"X Shen","year":"2017","unstructured":"Shen X, Zhang Y, Wu X, Guo Y, Shi W, Qi J, et al. Upregulated lncRNA-PCAT1 is closely related to clinical diagnosis of multiple myeloma as a predictive biomarker in serum. Cancer Biomark. 2017;18:257\u201363.","journal-title":"Cancer Biomark"},{"key":"527_CR19","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1111\/bjh.13383","volume":"169","author":"M Weinstock","year":"2015","unstructured":"Weinstock M, Aljawai Y, Morgan EA, Laubach J, Gannon M, Roccaro AM, et al. Incidence and clinical features of extramedullary multiple myeloma in patients who underwent stem cell transplantation. Br J Haematol. 2015;169:851\u20138.","journal-title":"Br J Haematol"},{"key":"527_CR20","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.1002\/stem.1989","volume":"33","author":"W Zhuang","year":"2015","unstructured":"Zhuang W, Ge X, Yang S, Huang M, Zhuang W, Chen P, et al. Upregulation of lncRNA MEG3 promotes osteogenic differentiation of mesenchymal stem cells from multiple myeloma patients by targeting BMP4 transcription. Stem Cells. 2015;33:1985\u201397.","journal-title":"Stem Cells"},{"key":"527_CR21","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1111\/bjh.14882","volume":"179","author":"H Handa","year":"2017","unstructured":"Handa H, Kuroda Y, Kimura K, Masuda Y, Hattori H, Alkebsi L, et al. Long non\u2010coding RNA MALAT 1 is an inducible stress response gene associated with extramedullary spread and poor prognosis of multiple myeloma. Br J Haematol. 2017;179:449\u201360.","journal-title":"Br J Haematol"},{"key":"527_CR22","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1002\/path.1680","volume":"205","author":"M Kremer","year":"2005","unstructured":"Kremer M, Ott G, Nathrath M, Specht K, Stecker K, Alexiou C, et al. Primary extramedullary plasmacytoma and multiple myeloma: phenotypic differences revealed by immunohistochemical analysis. J Pathol. 2005;205:92\u2013101.","journal-title":"J Pathol"},{"key":"527_CR23","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1046\/j.1365-2141.2002.03258.x","volume":"116","author":"IM Dahl","year":"2002","unstructured":"Dahl IM, Rasmussen T, Kauric G, Husebekk A. Differential expression of CD56 and CD44 in the evolution of extramedullary myeloma. Br J Haematol. 2002;116:273\u20137.","journal-title":"Br J Haematol"},{"key":"527_CR24","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1111\/ejh.12377","volume":"93","author":"HJ Shin","year":"2014","unstructured":"Shin HJ, Kim K, Lee JW, Song MK, Lee JJ, Lee HS, et al. Comparison of outcomes after autologous stem cell transplantation between myeloma patients with skeletal and soft tissue plasmacytoma. Eur J Haematol. 2014;93:414\u201321.","journal-title":"Eur J Haematol"},{"key":"527_CR25","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1111\/ejh.12688","volume":"97","author":"L Besse","year":"2016","unstructured":"Besse L, Sedlarikova L, Greslikova H, Kupska R, Almasi M, Penka M, et al. Cytogenetics in multiple myeloma patients progressing into extramedullary disease. Eur J Haematol. 2016;97:93\u2013100.","journal-title":"Eur J Haematol"},{"key":"527_CR26","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1002\/ajh.25579","volume":"94","author":"I Avivi","year":"2019","unstructured":"Avivi I, Cohen YC, Suska A, Shragai T, Mikala G, Garderet L, et al. Hematogenous extramedullary relapse in multiple myeloma\u2014a multicenter retrospective study in 127 patients. Am J Hematol. 2019;94:1132\u201340.","journal-title":"Am J Hematol"},{"key":"527_CR27","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.clml.2014.12.007","volume":"15","author":"H-J Shin","year":"2015","unstructured":"Shin H-J, Kim K, Lee JJ, Song MK, Lee EY, Park SH, et al. The t (11; 14)(q13; q32) translocation as a poor prognostic parameter for autologous stem cell transplantation in myeloma patients with extramedullary plasmacytoma. Clin Lymphoma Myeloma Leuk. 2015;15:227\u201335.","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"527_CR28","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1016\/j.bbmt.2019.07.004","volume":"25","author":"N Gagelmann","year":"2019","unstructured":"Gagelmann N, Eikema DJ, Koster L, Caillot D, Pioltelli P, Lleonart JB, et al. Tandem autologous stem cell transplantation improves outcomes in newly diagnosed multiple myeloma with extramedullary disease and high-risk cytogenetics: a study from the Chronic Malignancies Working Party of the European Society for blood and marrow transplantation. Biol Blood Marrow Transplant. 2019;25:2134\u201342.","journal-title":"Biol Blood Marrow Transplant"},{"key":"527_CR29","doi-asserted-by":"publisher","first-page":"10.","DOI":"10.1186\/s13045-017-0549-1","volume":"11","author":"J Caers","year":"2018","unstructured":"Caers J, Paiva B, Zamagni E, Leleu X, Blad\u00e9 J, Kristinsson SY, et al. Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel. J Hematol Oncol. 2018;11:10.","journal-title":"J Hematol Oncol"},{"key":"527_CR30","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1111\/bjh.13382","volume":"169","author":"C Varga","year":"2015","unstructured":"Varga C, Xie W, Laubach J, Ghobrial IM, O'Donnell EK, Weinstock M, et al. Development of extramedullary myeloma in the era of novel agents: no evidence of increased risk with lenalidomide-bortezomib combinations. Br J Haematol. 2015;169:843\u201350.","journal-title":"Br J Haematol"},{"key":"527_CR31","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1038\/bmt.2017.165","volume":"52","author":"L Kumar","year":"2017","unstructured":"Kumar L, Gogi R, Patel AK, Mookerjee A, Sahoo RK, Malik PS, et al. Multiple myeloma with extramedullary disease: impact of autologous stem cell transplantation on outcome. Bone Marrow Transplant. 2017;52:1473\u20135.","journal-title":"Bone Marrow Transplant"},{"key":"527_CR32","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1002\/ajh.24954","volume":"93","author":"A Lakshman","year":"2018","unstructured":"Lakshman A, Singh PP, Rajkumar SV, Dispenzieri A, Lacy MQ, Gertz MA, et al. Efficacy of VDT PACE\u2010like regimens in treatment of relapsed\/refractory multiple myeloma. Am J Hematol. 2018;93:179\u201386.","journal-title":"Am J Hematol"},{"key":"527_CR33","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1007\/s00277-014-2023-2","volume":"93","author":"L Rasche","year":"2014","unstructured":"Rasche L, Strifler S, Duell J, Rosenwald A, Buck A, Maeder U, et al. The lymphoma-like polychemotherapy regimen \u201cDexa-BEAM\u201d in advanced and extramedullary multiple myeloma. Annals Hematol. 2014;93:1207\u201314.","journal-title":"Annals Hematol"},{"key":"527_CR34","doi-asserted-by":"publisher","first-page":"1035.","DOI":"10.3390\/cancers12041035","volume":"12","author":"X Zhou","year":"2020","unstructured":"Zhou X, Fl\u00fcchter P, Nickel K, Meckel K, Messerschmidt J, B\u00f6ckle D, et al. Carfilzomib based treatment strategies in the management of relapsed\/refractory multiple myeloma with extramedullary disease. Cancers. 2020;12:1035.","journal-title":"Cancers"},{"key":"527_CR35","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1002\/cncr.26447","volume":"118","author":"A Gozzetti","year":"2012","unstructured":"Gozzetti A, Cerase A, Lotti F, Rossi D, Palumbo A, Petrucci MT, et al. Extramedullary intracranial localization of multiple myeloma and treatment with novel agents: a retrospective survey of 50 patients. Cancer. 2012;118:1574\u201384.","journal-title":"Cancer"},{"key":"527_CR36","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1182\/blood-2015-07-635383","volume":"127","author":"C Touzeau","year":"2016","unstructured":"Touzeau C, Moreau P. How I treat extramedullary myeloma. Blood. 2016;127:971\u20136.","journal-title":"Blood"},{"key":"527_CR37","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.3324\/haematol.2020.248518","volume":"105","author":"PA Egan","year":"2020","unstructured":"Egan PA, Elder PT, Deighan WI, O\u2019Connor SJM, Alexander HD. Multiple myeloma with central nervous system relapse. Haematologica. 2020;105:1780\u201390.","journal-title":"Haematologica"},{"key":"527_CR38","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1182\/blood-2016-03-705210","volume":"128","author":"SZ Usmani","year":"2016","unstructured":"Usmani SZ, Weiss BM, Plesner T, Bahlis NJ, Belch A, Lonial S, et al. Clinical efficacy of daratumumab monotherapy in patients with heavily pretreated relapsed or refractory multiple myeloma. Blood. 2016;128:37\u201344.","journal-title":"Blood"},{"key":"527_CR39","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1038\/nm.3910","volume":"21","author":"AP Rapoport","year":"2015","unstructured":"Rapoport AP, Stadtmauer EA, Binder-Scholl GK, Goloubeva O, Vogl DT, Lacey SF, et al. NY-ESO-1\u2013specific TCR\u2013engineered T cells mediate sustained antigen-specific antitumor effects in myeloma. Nat Med. 2015;21:914\u201321.","journal-title":"Nat Med"},{"key":"527_CR40","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1111\/ejh.13380","volume":"104","author":"N Gagelmann","year":"2020","unstructured":"Gagelmann N, Ayuk F, Atanackovic D, Kr\u00f6ger N. B cell maturation antigen\u2010specific chimeric antigen receptor T cells for relapsed or refractory multiple myeloma: A meta\u2010analysis. Eur J Haematol. 2020;104:318\u201327.","journal-title":"Eur J Haematol"},{"key":"527_CR41","doi-asserted-by":"crossref","unstructured":"Cavo M, Goldschmidt H, Rosinol L, Pantani L, Zweegman S, Salwender HJ, et al. Double vs single autologous stem cell transplantation for newly diagnosed multiple myeloma: long-term follow-up (10-years) analysis of randomized phase 3 studies. Am Soc Hematology 2018.","DOI":"10.1182\/blood-2018-99-112899"},{"key":"527_CR42","doi-asserted-by":"crossref","unstructured":"Cavo M, Salwender H, Rosi\u00f1ol L, Moreau P, Petrucci MT, Blau IW, et al. Double vs single autologous stem cell transplantation after bortezomib-based induction regimens for multiple myeloma: an integrated analysis of patient-level data from phase European III studies. American Society of Hematology Washington, DC; 2013.","DOI":"10.1182\/blood.V122.21.767.767"},{"key":"527_CR43","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1038\/sj.leu.2404085","volume":"20","author":"JA P\u00e9rez-Sim\u00f3n","year":"2006","unstructured":"P\u00e9rez-Sim\u00f3n JA, Sureda A, Fern\u00e1ndez-Aviles F, Sampol A, Cabrera JR, Caballero D, et al. Reduced-intensity conditioning allogeneic transplantation is associated with a high incidence of extramedullary relapses in multiple myeloma patients. Leukemia. 2006;20:542\u20135.","journal-title":"Leukemia"},{"key":"527_CR44","doi-asserted-by":"publisher","DOI":"10.1186\/s12935-018-0553-8","volume":"18","author":"X Yin","year":"2018","unstructured":"Yin X, Tang L, Fan F, Jiang Q, Sun C, Hu Y. Allogeneic stem-cell transplantation for multiple myeloma: a systematic review and meta-analysis from 2007 to 2017. Cancer Cell Int. 2018;18:62.","journal-title":"Cancer Cell Int"},{"key":"527_CR45","doi-asserted-by":"publisher","first-page":"1988","DOI":"10.1016\/j.bbmt.2016.08.024","volume":"22","author":"L Rasche","year":"2016","unstructured":"Rasche L, R\u00f6llig C, Stuhler G, Danhof S, Mielke S, Grigoleit GU, et al. Allogeneic hematopoietic cell transplantation in multiple myeloma: focus on longitudinal assessment of donor chimerism, extramedullary disease, and high-risk cytogenetic features. Biol Blood Marrow Transplant. 2016;22:1988\u201396.","journal-title":"Biol Blood Marrow Transplant"},{"key":"527_CR46","doi-asserted-by":"crossref","unstructured":"Beksac M, Cengiz Seval G, Kanellias N, Coriu D, Rosinol L, Ozet G, et al. A real world multicenter retrospective study on extramedullary disease from Balkan Myeloma Study Group and Barcelona University: analysis of parameters that improve outcome. Haematologica 2019;105:201\u20138.","DOI":"10.3324\/haematol.2019.219295"},{"key":"527_CR47","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/j.survophthal.2009.04.012","volume":"54","author":"CN Burkat","year":"2009","unstructured":"Burkat CN, Van Buren JJ, Lucarelli MJ. Characteristics of orbital multiple myeloma: a case report and literature review. Surv Ophthalmol. 2009;54:697\u2013704.","journal-title":"Surv Ophthalmol"},{"key":"527_CR48","doi-asserted-by":"publisher","first-page":"243","DOI":"10.4103\/jpgm.JPGM_623_17","volume":"64","author":"N Tahiliani","year":"2018","unstructured":"Tahiliani N, Kataria P, Patel A, Kendre P. Proptosis and hemiplegia as an initial manifestation of multiple myeloma. J Postgrad Med. 2018;64:243\u20136.","journal-title":"J Postgrad Med"},{"key":"527_CR49","unstructured":"Norlia, A. Recurrent multiple myeloma presenting as a breast plasmacytoma. Med J Malaysia. 2010;65:227\u20138."},{"key":"527_CR50","first-page":"7348504.","volume":"2019","author":"AM Khan","year":"2019","unstructured":"Khan AM, Azar I, Najjar S, Bevington T, Mehdi S. A case of aggressive multiple myeloma with extramedullary involvement of the female reproductive system, thyroid and breasts. Case Rep Hematol. 2019;2019:7348504.","journal-title":"Case Rep Hematol"},{"key":"527_CR51","doi-asserted-by":"publisher","first-page":"552","DOI":"10.4103\/ijmpo.ijmpo_43_16","volume":"38","author":"K Singh","year":"2017","unstructured":"Singh K, Kumar P, Pruthy R, Goyal G. Multiple myeloma presenting as thyroid plasmacytoma. Indian J Med Paediatr Oncol. 2017;38:552\u20134.","journal-title":"Indian J Med Paediatr Oncol"},{"key":"527_CR52","first-page":"145561319861379","volume":"100","author":"WS You","year":"2019","unstructured":"You WS, Bhuta S. Myeloma of laryngeal cartilage: literature review and case study. Ear Nose Throat J. 2019;100:145561319861379\u2013NP119.","journal-title":"Ear Nose Throat J"},{"key":"527_CR53","doi-asserted-by":"publisher","DOI":"10.1186\/s13256-017-1382-4","volume":"11","author":"E Cantone","year":"2017","unstructured":"Cantone E, Di Lullo AM, Marano L, Guadagno E, Mansueto G, Capriglione P, et al. Strategy for the treatment and follow-up of sinonasal solitary extramedullary plasmacytoma: a case series. J Med Case Rep. 2017;11:219.","journal-title":"J Med Case Rep"},{"key":"527_CR54","doi-asserted-by":"crossref","unstructured":"D'Aguillo C, Soni RS, Gordhan C, Liu JK, Baredes S, Eloy JA, editors. Sinonasal extramedullary plasmacytoma: a systematic review of 175 patients. in International forum of allergy & rhinology. 2014. Wiley Online Library.","DOI":"10.1002\/alr.21254"},{"key":"527_CR55","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.clml.2018.12.003","volume":"19","author":"U Yanamandra","year":"2019","unstructured":"Yanamandra U, Deo P, Sahu KK, Nampoothiri RV, Gupta N, Prabhakaran A, et al. Clinicopathological profile of myelomatous pleural effusion: single-center real-world experience and review of literature. Clin Lymphoma Myeloma Leuk. 2019;19:183\u20139. e1","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"527_CR56","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/ajh.1067","volume":"67","author":"K Oshima","year":"2001","unstructured":"Oshima K, Kanda Y, Nannya Y, Kaneko M, Hamaki T, Suguro M, et al. Clinical and pathologic findings in 52 consecutively autopsied cases with multiple myeloma. Am J Hematol. 2001;67:1\u20135.","journal-title":"Am J Hematol"},{"key":"527_CR57","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1080\/10428190400011583","volume":"46","author":"W Abelman","year":"2005","unstructured":"Abelman W, Virchis A, Yong K. Extramedullary myeloma representing as a pericardial effusion with tamponade: two case reports and a further review of 19 cases in the literature. Leukemia Lymphoma. 2005;46:137\u201342.","journal-title":"Leukemia Lymphoma"},{"key":"527_CR58","doi-asserted-by":"publisher","first-page":"e16567","DOI":"10.1097\/MD.0000000000016567","volume":"98","author":"X Wang","year":"2019","unstructured":"Wang X, Xie H, Zhang L. Multiple myeloma with onset of pancreas involvement: a case report. Medicine. 2019;98:e16567.","journal-title":"Medicine"},{"key":"527_CR59","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1200\/JCO.2002.20.1.344","volume":"20","author":"CS Chim","year":"2002","unstructured":"Chim CS, Wong WM, Nicholls J, Chung LP, Liang R. Extramedullary sites of involvement in hematologic malignancies: case 3. Hemorrhagic gastric plasmacytoma as the primary presentation in multiple myeloma. J Clin Oncol. 2002;20:344\u20137.","journal-title":"J Clin Oncol"},{"key":"527_CR60","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1177\/014107688708000318","volume":"80","author":"S Karp","year":"1987","unstructured":"Karp S, Shareef D. Ascites as a presenting feature of multiple myeloma. J R Soc Med. 1987;80:182\u20134.","journal-title":"J R Soc Med"},{"key":"527_CR61","doi-asserted-by":"publisher","first-page":"100971.","DOI":"10.1016\/j.eucr.2019.100971","volume":"26","author":"K Yamashita","year":"2019","unstructured":"Yamashita K, Horiuchi T, Hayashida A, Tachibana H, Toki D, Kondo T. Multiple myeloma with testicular involvement: a case report. Urol Case Rep. 2019;26:100971.","journal-title":"Urol Case Rep"},{"key":"527_CR62","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.3109\/10428194.2015.1128542","volume":"57","author":"A Jurczyszyn","year":"2016","unstructured":"Jurczyszyn A, Olszewska-Szopa M, Hungria V, Crusoe E, Pika T, Delforge M, et al. Cutaneous involvement in multiple myeloma: a multi-institutional retrospective study of 53 patients. Leuk Lymphoma. 2016;57:2071\u20136.","journal-title":"Leuk Lymphoma"},{"key":"527_CR63","unstructured":"Evans LA, Jevremovic D, Nandakumar B, Dispenzieri A, Buadi FK, Dingli D, et al. Utilizing multiparametric flow cytometry in the diagnosis of patients with primary plasma cell leukemia. Am J Hematol. n\/a(n\/a)."}],"container-title":["Blood Cancer Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41408-021-00527-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41408-021-00527-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41408-021-00527-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T18:23:38Z","timestamp":1669919018000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41408-021-00527-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,29]]},"references-count":63,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["527"],"URL":"https:\/\/doi.org\/10.1038\/s41408-021-00527-y","relation":{},"ISSN":["2044-5385"],"issn-type":[{"value":"2044-5385","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,29]]},"assertion":[{"value":"14 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2021","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 July 2021","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 September 2021","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"161"}}