Post-progression outcomes following BCMA-directed CAR T-cell therapy in myeloma: Impact of extramedullary and paramedullary disease

This retrospective study of 106 multiple myeloma patients who progressed after BCMA CAR T-cell therapy characterizes progression patterns. Extramedullary disease (EMD) was detected in 51% of patients at progression. The presence of EMD, both at baseline or progression, was significantly associated with inferior overall and progression-free survival outcomes post-progression. The findings reinforce EMD's adverse prognosis and highlight the critical need for imaging surveillance and prospective investigation of bridging or maintenance strategies in this high-risk subgroup.