{"id":"https://openalex.org/W7156932757","doi":"https://doi.org/10.48550/arxiv.2604.24473","title":"Agentic clinical reasoning over longitudinal myeloma records: a retrospective evaluation against expert consensus","display_name":"Agentic clinical reasoning over longitudinal myeloma records: a retrospective evaluation against expert consensus","publication_year":2026,"publication_date":"2026-04-27","ids":{"openalex":"https://openalex.org/W7156932757","doi":"https://doi.org/10.48550/arxiv.2604.24473"},"language":null,"primary_location":{"id":"doi:10.48550/arxiv.2604.24473","is_oa":true,"landing_page_url":"https://doi.org/10.48550/arxiv.2604.24473","pdf_url":null,"source":{"id":"https://openalex.org/S4306400194","display_name":"arXiv (Cornell University)","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I205783295","host_organization_name":"Cornell University","host_organization_lineage":["https://openalex.org/I205783295"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":null,"is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"article"},"type":"preprint","indexed_in":["datacite"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://doi.org/10.48550/arxiv.2604.24473","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5134750333","display_name":"Johannes Moll","orcid":null},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Moll, Johannes","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5085736208","display_name":"Jannik L\u00fcbberstedt","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"L\u00fcbberstedt, Jannik","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5117134271","display_name":"Christoph Nuernbergk","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Nuernbergk, Christoph","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5083696637","display_name":"Jacob Stroh","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Stroh, Jacob","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5117587736","display_name":"Luisa Mertens","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Mertens, Luisa","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5078793182","display_name":"Anna Purcarea","orcid":"https://orcid.org/0000-0003-0111-714X"},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Purcarea, Anna","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134820973","display_name":"Christopher Zirn","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Zirn, Christopher","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134769550","display_name":"Zeineb Benchaaben","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Benchaaben, Zeineb","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134768354","display_name":"Fabian Drexel","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Drexel, Fabian","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5097357148","display_name":"Hartmut H\u00e4ntze","orcid":"https://orcid.org/0000-0002-6204-571X"},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"H\u00e4ntze, Hartmut","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5077142198","display_name":"Anirudh Narayanan","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Narayanan, Anirudh","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5093254071","display_name":"Friedrich Puttkammer","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Puttkammer, Friedrich","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134792278","display_name":"Andrei Zhukov","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Zhukov, Andrei","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5031142912","display_name":"Jacqueline Lammert","orcid":"https://orcid.org/0000-0002-0380-574X"},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Lammert, Jacqueline","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134751375","display_name":"Sebastian Ziegelmayer","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Ziegelmayer, Sebastian","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134754996","display_name":"Markus Graf","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Graf, Markus","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5003533631","display_name":"Marion H\u00f6gner","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"H\u00f6gner, Marion","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5125774423","display_name":"Marcus Makowski","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Makowski, Marcus","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5121322300","display_name":"Florian Bassermann","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Bassermann, Florian","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134785896","display_name":"Lisa C. Adams","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Adams, Lisa C.","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134811522","display_name":"Jiazhen Pan","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Pan, Jiazhen","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134799809","display_name":"Daniel Rueckert","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Rueckert, Daniel","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5012026477","display_name":"Krischan Braitsch","orcid":"https://orcid.org/0000-0003-4028-5357"},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Braitsch, Krischan","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5134800254","display_name":"Keno K. Bressem","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Bressem, Keno K.","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":24,"corresponding_author_ids":["https://openalex.org/A5134750333"],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10649","display_name":"Multiple Myeloma Research and Treatments","score":0.288100004196167,"subfield":{"id":"https://openalex.org/subfields/2720","display_name":"Hematology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10649","display_name":"Multiple Myeloma Research and Treatments","score":0.288100004196167,"subfield":{"id":"https://openalex.org/subfields/2720","display_name":"Hematology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10028","display_name":"Topic Modeling","score":0.1136000007390976,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T12574","display_name":"Clinical Reasoning and Diagnostic Skills","score":0.08420000225305557,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/decile","display_name":"Decile","score":0.7250000238418579},{"id":"https://openalex.org/keywords/concordance","display_name":"Concordance","score":0.6467000246047974},{"id":"https://openalex.org/keywords/multiple-myeloma","display_name":"Multiple myeloma","score":0.4620000123977661},{"id":"https://openalex.org/keywords/retrospective-cohort-study","display_name":"Retrospective cohort study","score":0.43790000677108765},{"id":"https://openalex.org/keywords/expert-system","display_name":"Expert system","score":0.4172999858856201},{"id":"https://openalex.org/keywords/inference","display_name":"Inference","score":0.37540000677108765},{"id":"https://openalex.org/keywords/medline","display_name":"MEDLINE","score":0.3287999927997589},{"id":"https://openalex.org/keywords/categorization","display_name":"Categorization","score":0.27549999952316284}],"concepts":[{"id":"https://openalex.org/C147021879","wikidata":"https://www.wikidata.org/wiki/Q3027971","display_name":"Decile","level":2,"score":0.7250000238418579},{"id":"https://openalex.org/C160798450","wikidata":"https://www.wikidata.org/wiki/Q4230870","display_name":"Concordance","level":2,"score":0.6467000246047974},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.5861999988555908},{"id":"https://openalex.org/C2776364478","wikidata":"https://www.wikidata.org/wiki/Q467635","display_name":"Multiple myeloma","level":2,"score":0.4620000123977661},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.43790000677108765},{"id":"https://openalex.org/C58328972","wikidata":"https://www.wikidata.org/wiki/Q184609","display_name":"Expert system","level":2,"score":0.4172999858856201},{"id":"https://openalex.org/C2776214188","wikidata":"https://www.wikidata.org/wiki/Q408386","display_name":"Inference","level":2,"score":0.37540000677108765},{"id":"https://openalex.org/C19527891","wikidata":"https://www.wikidata.org/wiki/Q1120908","display_name":"Medical physics","level":1,"score":0.37229999899864197},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.3287999927997589},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.32030001282691956},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.2994000017642975},{"id":"https://openalex.org/C94124525","wikidata":"https://www.wikidata.org/wiki/Q912550","display_name":"Categorization","level":2,"score":0.27549999952316284},{"id":"https://openalex.org/C119857082","wikidata":"https://www.wikidata.org/wiki/Q2539","display_name":"Machine learning","level":1,"score":0.27459999918937683},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.2660999894142151},{"id":"https://openalex.org/C2989236134","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Patient care","level":2,"score":0.26429998874664307},{"id":"https://openalex.org/C2779974597","wikidata":"https://www.wikidata.org/wiki/Q28448986","display_name":"Clinical Practice","level":2,"score":0.2639000117778778},{"id":"https://openalex.org/C155512373","wikidata":"https://www.wikidata.org/wiki/Q287450","display_name":"Residual","level":2,"score":0.2623000144958496},{"id":"https://openalex.org/C535046627","wikidata":"https://www.wikidata.org/wiki/Q30612","display_name":"Clinical trial","level":2,"score":0.2621999979019165},{"id":"https://openalex.org/C2777895361","wikidata":"https://www.wikidata.org/wiki/Q1758614","display_name":"Longitudinal study","level":2,"score":0.2621999979019165},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.26030001044273376},{"id":"https://openalex.org/C19648533","wikidata":"https://www.wikidata.org/wiki/Q691640","display_name":"Evidence-based medicine","level":3,"score":0.25450000166893005},{"id":"https://openalex.org/C203092338","wikidata":"https://www.wikidata.org/wiki/Q1340863","display_name":"Clinical endpoint","level":3,"score":0.25110000371932983}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.48550/arxiv.2604.24473","is_oa":true,"landing_page_url":"https://doi.org/10.48550/arxiv.2604.24473","pdf_url":null,"source":{"id":"https://openalex.org/S4306400194","display_name":"arXiv (Cornell University)","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I205783295","host_organization_name":"Cornell University","host_organization_lineage":["https://openalex.org/I205783295"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":null,"is_accepted":false,"is_published":null,"raw_source_name":null,"raw_type":"article"}],"best_oa_location":{"id":"doi:10.48550/arxiv.2604.24473","is_oa":true,"landing_page_url":"https://doi.org/10.48550/arxiv.2604.24473","pdf_url":null,"source":{"id":"https://openalex.org/S4306400194","display_name":"arXiv (Cornell University)","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I205783295","host_organization_name":"Cornell University","host_organization_lineage":["https://openalex.org/I205783295"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":null,"is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/16","display_name":"Peace, Justice and strong institutions","score":0.42812493443489075}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":[],"abstract_inverted_index":{"Multiple":[0],"myeloma":[1,58],"is":[2,247],"managed":[3],"through":[4],"sequential":[5],"lines":[6],"of":[7,26,56,199,207,236],"therapy":[8],"over":[9],"years":[10],"to":[11,24,190,216],"decades,":[12],"with":[13,73,114,157,170,221],"each":[14],"decision":[15],"depending":[16],"on":[17,52,76,94,124,163,224],"cumulative":[18],"disease":[19],"history":[20],"distributed":[21],"across":[22],"dozens":[23],"hundreds":[25],"heterogeneous":[27],"clinical":[28,54,234],"documents.":[29],"Whether":[30],"LLM-based":[31],"systems":[32],"can":[33],"synthesise":[34],"this":[35],"evidence":[36],"at":[37,61,101],"a":[38,62,125],"level":[39],"approaching":[40],"expert":[41,191,208],"agreement":[42],"has":[43],"not":[44],"been":[45],"established.":[46],"A":[47],"retrospective":[48],"evaluation":[49,243],"was":[50,82,188,196,212],"conducted":[51],"longitudinal":[53],"records":[55],"811":[57],"patients":[59],"treated":[60],"tertiary":[63],"centre":[64],"(2001-2026),":[65],"covering":[66],"44,962":[67],"documents":[68],"and":[69,91,120,147,153,169,229],"1,334,677":[70],"laboratory":[71],"values,":[72],"external":[74],"validation":[75],"MIMIC-IV.":[77],"An":[78],"agentic":[79,135],"reasoning":[80,211],"system":[81,136,184,200,238],"compared":[83],"against":[84],"single-pass":[85],"retrieval-augmented":[86],"generation":[87],"(RAG),":[88],"iterative":[89],"RAG,":[90],"full-context":[92,121],"input":[93,122],"469":[95],"patient-question":[96],"pairs":[97],"from":[98,108],"48":[99],"templates":[100],"three":[102],"complexity":[103],"levels.":[104],"Reference":[105],"labels":[106],"came":[107],"double":[109],"annotation":[110],"by":[111],"four":[112],"oncologists":[113],"senior":[115],"haematologist":[116],"adjudication.":[117],"Iterative":[118],"RAG":[119],"converged":[123],"shared":[126,219],"ceiling":[127],"(75.4%":[128],"vs":[129],"75.8%,":[130],"p":[131,150],"=":[132,151,167,181],"1.00).":[133],"The":[134,183,232],"reached":[137],"79.6%":[138],"concordance":[139],"(95%":[140],"CI":[141],"76.4-82.8),":[142],"exceeding":[143],"both":[144],"baselines":[145],"(+3.8":[146],"+4.2":[148],"pp;":[149],"0.006":[152],"0.007).":[154],"Gains":[155],"rose":[156],"question":[158],"complexity,":[159],"reaching":[160,173],"+9.4":[161],"pp":[162,175],"criteria-based":[164],"synthesis":[165],"(p":[166],"0.032),":[168],"record":[171],"length,":[172],"+13.5":[174],"in":[176,244],"the":[177,213,218,225],"top":[178],"decile":[179],"(n":[180],"10).":[182],"error":[185],"rate":[186],"(12.2%)":[187],"comparable":[189],"disagreement":[192],"(13.6%),":[193],"but":[194],"severity":[195],"inverted:":[197],"57.8%":[198],"errors":[201,239],"were":[202],"clinically":[203],"significant":[204],"versus":[205],"18.8%":[206],"disagreements.":[209],"Agentic":[210],"only":[214],"approach":[215],"exceed":[217],"ceiling,":[220],"gains":[222],"concentrated":[223],"most":[226],"complex":[227],"questions":[228],"longest":[230],"records.":[231],"greater":[233],"consequence":[235],"residual":[237],"indicates":[240],"that":[241],"prospective":[242],"routine":[245],"care":[246],"required":[248],"before":[249],"these":[250],"findings":[251],"translate":[252],"into":[253],"patient":[254],"benefit.":[255]},"counts_by_year":[],"updated_date":"2026-04-29T06:16:36.941037","created_date":"2026-04-29T00:00:00"}