diff --git a/monai/transforms/transform.py b/monai/transforms/transform.py
index 1a365b8d8e..05a08e0743 100644
--- a/monai/transforms/transform.py
+++ b/monai/transforms/transform.py
@@ -143,10 +143,16 @@ def apply_transform(
     try:
         map_items_ = int(map_items) if isinstance(map_items, bool) else map_items
         if isinstance(data, (list, tuple)) and map_items_ > 0:
-            return [
-                apply_transform(transform, item, map_items_ - 1, unpack_items, log_stats, lazy, overrides)
-                for item in data
-            ]
+            res: list[Any] = []
+            for item in data:
+                res_item = apply_transform(transform, item, map_items_ - 1, unpack_items, log_stats, lazy, overrides)
+                # Only extend if we're at the leaf level (map_items_ == 1) and the transform
+                # actually returned a list (not preserving nested structure)
+                if isinstance(res_item, list) and map_items_ == 1 and not isinstance(item, (list, tuple)):
+                    res.extend(res_item)
+                else:
+                    res.append(res_item)
+            return res
         return _apply_transform(transform, data, unpack_items, lazy, overrides, log_stats)
     except Exception as e:
         # if in debug mode, don't swallow exception so that the breakpoint
@@ -482,8 +488,7 @@ def key_iterator(self, data: Mapping[Hashable, Any], *extra_iterables: Iterable
                 yield (key,) + tuple(_ex_iters) if extra_iterables else key
             elif not self.allow_missing_keys:
                 raise KeyError(
-                    f"Key `{key}` of transform `{self.__class__.__name__}` was missing in the data"
-                    " and allow_missing_keys==False."
+                    f"Key `{key}` of transform `{self.__class__.__name__}` was missing in the data and allow_missing_keys==False."
                 )
 
     def first_key(self, data: dict[Hashable, Any]):
diff --git a/tests/transforms/compose/test_compose.py b/tests/transforms/compose/test_compose.py
index e6727c976f..01c7d92e7d 100644
--- a/tests/transforms/compose/test_compose.py
+++ b/tests/transforms/compose/test_compose.py
@@ -282,6 +282,34 @@ def test_flatten_and_len(self):
     def test_backwards_compatible_imports(self):
         from monai.transforms.transform import MapTransform, RandomizableTransform, Transform  # noqa: F401
 
+    def test_list_extend_multi_sample_trait(self):
+        center_crop = mt.CenterSpatialCrop([128, 128])
+        multi_sample_transform = mt.RandSpatialCropSamples([64, 64], 1)
+
+        img = torch.zeros([1, 512, 512])
+
+        self.assertEqual(execute_compose(img, [center_crop]).shape, torch.Size([1, 128, 128]))
+        single_multi_sample_trait_result = execute_compose(img, [multi_sample_transform, center_crop])
+        self.assertIsInstance(single_multi_sample_trait_result, list)
+        self.assertEqual(len(single_multi_sample_trait_result), 1)
+        self.assertEqual(single_multi_sample_trait_result[0].shape, torch.Size([1, 64, 64]))
+
+        double_multi_sample_trait_result = execute_compose(img, [multi_sample_transform, multi_sample_transform, center_crop])
+        self.assertIsInstance(double_multi_sample_trait_result, list)
+        self.assertEqual(len(double_multi_sample_trait_result), 1)
+        self.assertEqual(double_multi_sample_trait_result[0].shape, torch.Size([1, 64, 64]))
+
+    def test_multi_sample_trait_cardinality(self):
+        img = torch.zeros([1, 128, 128])
+        t2 = mt.RandSpatialCropSamples([32, 32], num_samples=2)
+
+        # chaining should multiply counts: 2 x 2 = 4, flattened
+        res = execute_compose(img, [t2, t2])
+        self.assertIsInstance(res, list)
+        self.assertEqual(len(res), 4)
+        for r in res:
+            self.assertEqual(r.shape, torch.Size([1, 32, 32]))
+
 
 TEST_COMPOSE_EXECUTE_TEST_CASES = [
     [None, tuple()],