{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:18:03Z","timestamp":1788351483488,"version":"build-2803163510"},"reference-count":17,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["KAKENHI grant (number 25K02477)"],"award-info":[{"award-number":["KAKENHI grant (number 25K02477)"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2026,5,11]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    Bone marrow represents a unique microenvironment enriched with both immunosuppressive cells and immune-activating functions. However, its role in metastasis and response to immunotherapy remains poorly understood. We report a case of sarcomatoid clear cell renal cell carcinoma with systemic bone marrow metastasis that achieved a complete response to ipilimumab plus nivolumab. Using matched pretreatment and post-treatment bone marrow samples, we performed integrative immune profiling. Pretreatment analyses showed abundant CD14\n                    <jats:sup>+<\/jats:sup>\n                    myeloid cells, phenotypically consistent with myeloid-derived suppressor cell (MDSC)-like populations, together with CD8\n                    <jats:sup>+<\/jats:sup>\n                    T cells. RNA-seq-based deconvolution revealed a predominance of monocytic-MDSC-like cells, which were selectively reduced after treatment with a shift toward monocyte and neutrophil-associated cells. Paired single-sample gene set enrichment analysis demonstrated that immunosuppressive (MDSC-like populations and TGF-\u03b2), and immune-activating (CD8\n                    <jats:sup>+<\/jats:sup>\n                    T cell, interferon-gamma) pathways coexisted at baseline and were broadly attenuated following treatment. These findings suggest that the bone marrow microenvironment harbored a hybrid immune state characterized by concurrent inflammatory and immunosuppressive programs. The subsequent global contraction of both programs suggests that immune remodeling primarily reflects the resolution of tumor-driven immune activation following tumor eradication, rather than the effect from immune checkpoint inhibitors. This case highlights that even in an immune-restrictive niche, latent but functional antitumor immunity can be unleashed by immune checkpoint blockade.\n                  <\/jats:p>","DOI":"10.1136\/jitc-2025-013940","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T13:50:10Z","timestamp":1779976210000},"page":"e013940","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Complete response to immune checkpoint blockade in sarcomatoid renal cell carcinoma with bone marrow metastasis: case report with tumor immune microenvironment profiling"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7091-628X","authenticated-orcid":false,"given":"Yuji","family":"Miura","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation For Cancer Research, Koto, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Jikuya","sequence":"additional","affiliation":[{"name":"Department of Urology, Yokohama City University, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asaki","family":"Saijo","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Toranomon Hospital, Minato, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromu","family":"Yano","sequence":"additional","affiliation":[{"name":"Department of Tumor Pathology, Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Kinowaki","sequence":"additional","affiliation":[{"name":"Department of Pathology, Toranomon Hospital, Minato, Tokyo, 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"2026090204401304000_14.5.e013940.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-021-01329-6"},{"key":"2026090204401304000_14.5.e013940.2","doi-asserted-by":"crossref","first-page":"104248","DOI":"10.1016\/j.critrevonc.2023.104248","article-title":"Comprehensive review of solid tumor bone marrow metastasis","volume":"194","author":"Zhang","year":"2024","journal-title":"Crit Rev Oncol 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