African American Multiple Myeloma Patients Research Articles

Fluorescence in Situ Hybridization (FISH) abnormalities and Baseline Clinical Features at Diagnosis in African American Multiple Myeloma Patients

BACKGROUND: Multiple myeloma (MM) is the most common hematologic malignancy in the African American (AA) population with an incidence more than 2-3 times higher than Caucasians [Landgren O et al Blood 2006]. In the pre-novel therapy era, SEER data [1975-2008] indicated better survival outcomes for AA patients with MM. However, with the recent advent of novel drugs for treatment of MM, the survival gap for Caucasian patients with MM has closed [Ailawadhi S et al Br J Haematol 2012]. A recent pooled analysis of diagnostic cytogenetics in 292 AA MM patients [Greenberg et al Blood Cancer J 2015] reported on differences in commonly observed baseline cytogenetic abnormalities (CA) between AA and Caucasian MM patients. The large and diverse population of patients with MM at our institution prompted us to examine diagnostic cytogenetics in our MM patients along with other clinical features.PATIENTS & METHODS: The MM database was interrogated for all patients presenting with MM between January 2012 and February 2016. Baseline clinical and pathology variables were compared between the AA and Caucasian cohorts. Continuous variables were compared using nonparametric rank tests, while incidences and proportions (e.g. CAs including t(11;14), t(4;14), t(14;16), t(14:20), amplification 1q21, monosomy13/del13q and del17p) were compared using Fisher’s exact tests.RESULTS: A total of 398 patients were identified for the analysis (African Americans n = 168, Caucasian n = 230). The median age of AA MM patients was significantly younger than Caucasian MM patients (median age 63 years vs. 68 years, p<0.0001), with a similar sex distribution. There was no significant difference in the degree of anemia, renal insufficiency, serum LDH levels, bone marrow flow cytometry, bone marrow cellularity or plasmacytosis in the two cohorts. Although there was a trend toward more ISS I amongst Caucasian MM patients, there was no statistical difference in ISS stages (p = 0.126) and no significant difference in R-ISS stage between the cohorts (p = 0.361). There was 72.7% agreement between the ISS and R-ISS staging (88 of 121 evaluable subjects had the same stage by ISS and R-ISS staging criteria), while 27.3% of the patients were upstaged from Stage I or II by ISS criteria to Stage III by R-ISS criteria. Of those upstaged, 19 patients were in the Caucasian cohort and 14 were in the AA cohort. The magnitude of this upstaging was significant when evaluated with a Generalized McNemar’s test (p < 0.001). Additionally, there was a similar incidence of common FISH abnormalities in the AA cohort compared to the Caucasian cohort [Table 1].CONCLUSIONS: This is the largest single institution report of FISH data in AA MM patients. Unlike previous reports, we show similar clinical, pathological, and cytogenetic features between AA and Caucasian patients with MM at presentation. It is possible that molecular abnormalities not detectable by FISH in our patient cohort could account for differences in our data and the published literature. [Display omitted] DisclosuresBhutani:Prothena: Research Funding; Takeda Oncology: Research Funding, Speakers Bureau; Bristol-Myers Squibb: Speakers Bureau; Onyx, an Amgen subsidiary: Speakers Bureau. Symanowski:Eli Lilly & Co: Consultancy; Ra Pharma: Consultancy; Caris Life Sciences: Consultancy; Endocyte: Consultancy. Avalos:Seattle Genetics: Membership on an entity’s Board of Directors or advisory committees. Usmani:Onyx: Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Consultancy, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Skyline: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Britsol-Myers Squibb: Consultancy, Research Funding; Takeda: Consultancy, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sanofi: Consultancy, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Millenium: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Array: Research Funding; Pharmacyclics: Research Funding; BioPharma: Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Research Funding, Speakers Bureau; Novartis: Speakers Bureau.

Outcomes in Transplant Eligible Multiple Myeloma African American Patients Appear Similar to Caucasian Patients

Background: SEER Data from 1975-2008 show a stark disparity in the incidence of multiple myeloma (MM) in African Americans (AA) compared to Caucasians, with a 2-3 times higher incidence in AA. Differences in the incidence appear to be genetically driven, but remain poorly understood. Although AA patients appear to have a lower incidence of high risk cytogenetics [Greenberg G et al, Blood Cancer J 2015], their outcomes have not improved in the novel era therapy compared to Caucasian patients [Ailawahdi S et al, Blood Cancer J 2016]. Access to specialized disease-specific care (including access to a transplant center) due to socioeconomic status and lack of social support have been proposed as impediments to optimal care for AA MM patients. We prospectively examined newly diagnosed transplant eligible AA and Caucasian patients with MM at our institution to assess their transplant outcomes.Methods: The MM database was interrogated from March 2014-December 2015 for all autologous stem cell transplant (ASCT) eligible patients with MM. Clinical features, induction regimens, treatment responses and ASCT outcomes were compared between AA and Caucasian patients. Continuous variables were compared using nonparametric rank tests, while incidences and proportions were compared using Fisher's exact tests.Results: A total of 73 consecutive ASCT eligible MM patients were identified (32 AA, 41 Caucasian). There was no significant difference in sex distribution between the cohorts (p > 0.999). However, AA patients were significantly younger at the time of diagnosis with a median age of 56 years compared to a median age of 61 years in the Caucasian cohort (p = 0.008). Except for lower hemoglobin levels among AA patients, there were no statistically significant differences in any other clinical variable at diagnosis (lab features, serum LDH levels, ISS staging, IMWG risk stratification, cytogenetics, etc.) between the patient cohorts. Analysis of pre- and post- ASCT data showed similar response rates to induction therapy and outcomes with no statistically significant differences observed in pre-ASCT and post-ASCT depth of response (assessed by IMWG criteria) or 1-year progression free survival between the two cohorts.Conclusions: At our institution, AA patients with MM presented at a younger age than Caucasians. However, no significant differences in disease features were observed between the two groups at the time of initial presentation. A much higher proportion of AA MM patients (44%) underwent ASCT at our institution compared to other academic centers. Although longer follow-up is required, our data suggest that when AA patients with MM are provided similar access to care as Caucasian patients with MM, similar response rates to induction therapy and ASCT can be achieved. DisclosuresBhutani:Prothena: Research Funding; Bristol-Myers Squibb: Speakers Bureau; Takeda Oncology: Research Funding, Speakers Bureau; Onyx, an Amgen subsidiary: Speakers Bureau. Symanowski:Caris Life Sciences: Consultancy; Ra Pharma: Consultancy; Eli Lilly & Co: Consultancy; Endocyte: Consultancy. Avalos:Seattle Genetics: Membership on an entity’s Board of Directors or advisory committees. Usmani:Celgene: Consultancy, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Pharmacyclics: Research Funding; Onyx: Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Skyline: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Takeda: Consultancy, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Britsol-Myers Squibb: Consultancy, Research Funding; BioPharma: Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sanofi: Consultancy, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Millenium: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Array: Research Funding; Amgen: Consultancy, Research Funding, Speakers Bureau; Novartis: Speakers Bureau.

Abstract B41: Distribution of cytogenetic abnormalities in African American multiple myeloma patients may be unique for different geographic regions

Abstract Background: Multiple myeloma (MM) is the most common hematologic malignancy in the African American population, with an incidence more than 2 times higher than Caucasian population [Landgren O et al Blood 2006]. Historically, the African American MM patients have had better outcomes compared with other races [Ailawadhi S et al Br J Haematol 2012], but no biologic explanations exist for this observation. Greenberg et al [Blood Cancer J 2015] have recently reported on differences in commonly observed baseline cytogenetic abnormalities (CA) between African American and Caucasian MM patients seen at Mayo Clinic (Rochester, MN), Cook County Hospital (Chicago, IL) and University of Maryland (Baltimore, MD). We examined the MM cohort at our referral center to validate these observations. Patients and Methods: The Levine Cancer Institute MM database was interrogated for all patients presenting with MM between January 2012 and April 2015. Baseline clinical and pathology variables were compared between the African American and Caucasian cohorts. Continuous variables were compared using nonparametric rank tests, while incidences and proportions (e.g. CAs including t(11;14), t(4;14), monosomy13/del13q and del17p) were compared using Fisher's exact tests. Results: A total of 662 patients were identified; excluding those with MGUS classification, 368 patients were included in the analysis (African Americans n = 130, Caucasian n = 238). The median age of African American MM patients was significantly younger than Caucasian MM patients (median age 60 years vs. 65 years, p=0.010), with similar gender distribution. There was a numerically larger proportion of African American patients with anemia (40.8% vs 30.8%, p =0.166), however, there was no significant difference in degree of BM plasmacytosis amongst the two groups. The overall distribution of MM patients by IMWG risk stratification (Chng et al, Leukemia 2013) was also similar between the two groups. The African American MM patients had a numerically higher incidence of a metaphase abnormality on conventional cytogenetics (21.7% vs. 13.9%, p =0.154). They had a significantly lower incidence of t(11;14) [7.7% vs. 16%, p=0.024], a numerically higher incidence of t(4;14) [6.2% vs. 3.8%, p=0.309], and similar incidence of deletion 13/del13q [22.3% vs. 18.9%, p=NS] and del17p [7.7% vs. 7.6%, p=NS]. Conclusions: The present dataset is the largest single institution report on CA racial differences in MM patients. We observed that unlike previous reports of lower incidence of t(4;14) or del17 p in African American MM patients by Greenberg et al, we have observed a higher incidence of t(4;14) and similar incidence of del17p in our experience compared to Caucasian MM patients. The different pattern of CA distribution compared to published literature may represent geographic heterogeneity and potentially influence survival outcomes. Citation Format: Preeya Patel, Manisha Bhutani, Kyle Madden, Myra R. Robinson, Rupali Bose, James Symanowski, Saad Z. Usmani. Distribution of cytogenetic abnormalities in African American multiple myeloma patients may be unique for different geographic regions. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B41.

Abstract IA07: Outcome disparities in multiple myeloma: The role of race/ethnicity

Abstract Approximately 27,000 new cases of multiple myeloma (MM) will be diagnosed and more than 11,000 deaths will occur from it in 2015. Overall, 5-year relative survival rates have improved from 26.5% in 1975 to 44.9% in 2010, and this has been attributed to the introduction of novel therapeutic agents, widespread utilization of autologous stem cell transplant (ASCT), and improvement in supportive care modalities. However, studies evaluating the role of race/ethnicity in MM have shown marked disparities in incidence and outcomes of MM among patients of different racial subgroups. Traditionally, it has been known that African-Americans (AA) have a higher incidence of MM than Whites and that it occurs in AA at a younger age. Despite this difference in incidence, AA patients are known to have a better overall survival (OS) than Whites. Recent population-based outcomes analyses of MM patients beyond just Whites and AA has shown that Asians have the best median OS, while Hispanics have the worst, in a population that is more representative of the current US racial/ethnic mix. Additionally, the cumulative survival benefit over time as per a recent report was most pronounced among Whites (1.3 years) and least among Asians (0.5 years), suggesting a possible differential access as well as utilization of therapeutic modalities. Thus, despite overall improvement in MM outcomes over years, racial disparities exist. While majority of the data so far has reported the existence of these outcome disparities, a few reports have explored the potential causes of these differences. With regards to disease biology, there is some data suggesting that MM patients belonging to different races may have variability in the incidence of high-risk mutations, with AA MM patients having a lower incidence of such mutations, supporting the better OS seen in AA patients as compared to Whites. Another suggestion supporting differences in an interaction between biologic and environmental factors in MM patients is the variability in incidence of second primary malignancies in patients after they have developed MM, which may affect their outcome and OS. Other causes of outcome disparities may include a differential access to certain treatment options, especially more complex ones like stem cell transplants, as well as certain novel therapeutic agents that may depend on the patient's insurance payer status, which brings up differences in socioeconomic status, education level and barriers in accessing healthcare. It has also been reported recently that access to comprehensive cancer centers has benefitted Whites more than racial minorities. While access issues are being reported for MM patients belonging to different races, it has been suggested that outcome disparities by race are not noted in equal access healthcare systems. The potential shortcomings for these studies in equal access healthcare systems though, have been small size, mostly single-institution and focusing primarily on Whites and AA, without much representation yet of Hispanics and Asians, despite these two racial subgroups being the fastest growing ones in the US. Outcome disparities in MM by patient race have been established. The factors affecting these outcome disparities may be complex and interrelated, making it difficult to identify specific factors that may be modifiable. Yet, it is important to explore outcome disparities and their potential causes, especially in large cohorts prospectively, so that healthcare resources may be utilized efficiently and furthermore, the disadvantaged population subgroups may be benefitted by targeted interventions. Citation Format: Sikander Ailawadhi. Outcome disparities in multiple myeloma: The role of race/ethnicity. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA07.

Distribution of Cytogenetic Abnormalities in African American Multiple Myeloma Patients May be Unique for Different Geographic Regions

BACKGROUND: Multiple myeloma (MM) is the most common hematologic malignancy in the African American population, with an incidence more than 2 times higher than Caucasian population [Landgren O et al Blood 2006]. Historically, the African American MM patients have had better outcomes compared with other races [Ailawadhi S et al Br J Haematol 2012], but no biologic explanations exist for this observation. Greenberg et al [Blood Cancer J 2015] have recently reported on differences in commonly observed baseline cytogenetic abnormalities (CA) between African American and Caucasian MM patients seen at Mayo Clinic (Rochester, MN), Cook County Hospital (Chicago, IL) and University of Maryland (Baltimore, MD). We examined the MM cohort at our referral center to validate these observations.PATIENTS & METHODS: The Levine Cancer Institute MM database was interrogated for all patients presenting with MM between January 2012 and April 2015. Baseline clinical and pathology variables were compared between the African American and Caucasian cohorts. Continuous variables were compared using nonparametric rank tests, while incidences and proportions (e.g. CAs including t(11;14), t(4;14), monosomy13/del13q and del17p) were compared using Fisher's exact tests.RESULTS: A total of 662 patients were identified; excluding those with MGUS classification, 368 patients were included in the analysis (African Americans n = 130, Caucasian n = 238). The median age of African American MM patients was significantly younger than Caucasian MM patients (median age 60 years vs. 65 years, p=0.010), with similar gender distribution. There was a numerically larger proportion of African American patients with anemia (40.8% vs 30.8%, p =0.166), however, there was no significant difference in degree of BM plasmacytosis amongst the two groups. The overall distribution of MM patients by IMWG risk stratification (Chng et al, Leukemia 2013) was also similar between the two groups. The African American MM patients had a numerically higher incidence of a metaphase abnormality on conventional cytogenetics (21.7% vs. 13.9%, p =0.154). They had a significantly lower incidence of t(11;14) [7.7% vs. 16%, p=0.024], a numerically higher incidence of t(4;14) [6.2% vs. 3.8%, p=0.309], and similar incidence of deletion 13/del13q [22.3% vs. 18.9%, p=NS ] and del17p [7.7% vs. 7.6%, p=NS ].CONCLUSIONS: The present dataset is the largest single institution report on CA racial differences in MM patients. We found that unlike previous reports of lower incidence of t(4;14) or del17 p in African American MM patients by Greenberg et al, we have observed a higher incidence of t(4;14) and similar incidence of del17p in our experience compared to Caucasian MM patients. The different pattern of CA distribution compared to published literature may represent geographic heterogeneity and potentially influence survival outcomes. DisclosuresCogdill:Celgene: Speakers Bureau; Onyx: Speakers Bureau; Millennium: Speakers Bureau; Novartis: Speakers Bureau. Usmani:Celgene: Honoraria, Speakers Bureau; Onyx: Honoraria, Research Funding, Speakers Bureau; Janssen Oncology: Honoraria, Research Funding; Sanofi: Honoraria, Research Funding; Pharmacyclics: Research Funding; Millennium: Honoraria, Speakers Bureau; Array BioPharma: Honoraria, Research Funding.

Abstract 3852: Obesity is associated with clinical characteristics in African American multiple myeloma patients

Abstract African-American ethnicity, male sex, older age and obesity are accepted risk factors for multiple myeloma (MM). Obesity early in life is a risk factor for many cancers, including MM; most studies have focused on populations of European origin. African-Americans have a higher prevalence of obesity than other populations, and may have a distinct genetic contribution to this condition. We established a multi-center study to investigate possible explanations for the excess risk of MM among African-Americans. The aim of the present case-case analysis was to determine whether body mass index (BMI) was associated with clinical characteristics at presentation in African-American MM patients. 1,065 patients diagnosed with active MM from January 1, 2009 through September 30, 2013 were recruited through nine outpatient centers at academic medical centers and 3 SEER population-based cancer registries. Information on weight and height at 20 years of age and at 5 years prior to diagnosis was obtained from questionnaires. Clinical information collected from the medical records and interviews included age at diagnosis, stage, percent plasmacytosis on bone marrow biopsy, B2 microglobulin level, immunoglobulin class and presence of lytic bone lesions. Molecular profiling abstracted from pathology reports included chromosomal gain/deletions (1P-, 1Q+, +3, +5, +7, +9, +11, 12P-, Del(13), +15, Del(17P), Del(17P13)), translocations (4;14), (11;14), and (14;16 ). Analysis of Variance (ANOVA) was used to test the null hypothesis that age at diagnosis was similar across BMI categories. A T-test was used to test the null hypothesis that the mean age at diagnosis in underweight/normal patients was not different than that for overweight and obese patients. The Mantel-Haenszel Chi square test for trend was used to test the null hypothesis that the proportion of cytogenetic and molecular abnormalities was similar across BMI categories. The study population consists of 306 African American male and 396 African American female MM patients. In both, obesity at 20 years of age was associated with younger age at diagnosis, compared to a normal/underweight (p=0.0015). Among males only, obesity at 5 years prior to diagnosis was also associated with younger age at diagnosis (p=0.03). A trend between increasing BMI and molecular characteristics associated with a poor prognosis was suggested. We observed a strong association between obesity at age 20 and younger age at diagnosis among males and females, and in males only at 5 years prior to diagnosis. Obesity is one of the few known potentially modifiable risk factors for MM. Younger age at diagnosis reflects an earlier accumulation of either or both genetic and environmental risk factors. We also observed a link between obesity at each of the two time points and specific molecular markers of poor prognosis. Additional studies are needed to determine biological significance of the results. Citation Format: Amie E. Hwang, Sikander Ailwadhi, Carol Ann Huff, Leon Bernal-Mizrachi, Christopher A. Haiman, Edward Peters, Seema Singhal, Karen Pawlish, Cathryn Bock, Todd Zimmerman, David J. Van Den Berg, David V. Conti, Brenda B. Birmann, Jayesh Mehta, John J. Graff, Daniel O. Stram, Niquelle Brown, Yang Yu, Moosa Azadian, Laurence Kolonel, Brian E. Henderson, Ann Mohrbacher, Graham Colditz, Brian-C Chiu, Michael Tomasson, Jeffrey Zonder, Robert Z. Orlowski, Sagar Lonial, Wendy Cozen. Obesity is associated with clinical characteristics in African American multiple myeloma patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3852. doi:10.1158/1538-7445.AM2014-3852

Obesity In Young Adulthood Is Associated With Early Onset Multiple Myeloma In African Americans

IntroductionAfrican-American ethnicity, male sex, older age and obesity are accepted risk factors for multiple myeloma (MM). Obesity early in life is a risk factor for many cancers, including MM; most studies have focused on populations of European origin. African-Americans have a higher prevalence of obesity than other populations, and may have a distinct genetic contribution to this condition. We established a multi-center collaborative study to investigate possible explanations for the excess risk of MM among African-Americans. The aim of the present case-case analysis was to determine whether body mass index (BMI) was associated with risk factors and clinical characteristics at presentation in African-American MM patients. MethodsPatients diagnosed with active MM since January 1, 2009 were recruited from nine outpatient centers and three Surveillance, Epidemiology, End-Results Program (SEER) population-based cancer registries. Information on weight and height at 20 years of age and at 5 years prior to diagnosis was obtained from questionnaires. Clinical information collected included age at diagnosis, stage, percent plasmacytosis on bone marrow biopsy, β2 microglobulin level, Ig serotype, light vs. heavy chain disease, and presence of lytic bone lesions. BMI (ht/wt2) was categorized into 3 levels (normal <25, overweight 25-29, obese >30) according to World Health Organization standard. The Pearson chi-square test was used to test the association between BMI category, and risk factors and clinical characteristics. Mean ages at diagnosis across BMI categories were compared using linear regression and a t-test for trend calculated. ResultsTo date, 1,044 African-American MM patients have been enrolled and of those, 1,014 provided a DNA sample. At present, 970 patients have completed a questionnaire, clinical records have been abstracted for 823 patients, and 509 patients have some information on gender, age at diagnosis, weight, height and clinical characteristics.The mean age at diagnosis was 59. Increasing BMI at age 20 was associated with younger age at diagnosis (p= 0.0004), whereas BMI at 5 years prior to diagnosis was not associated with age at diagnosis (p=0.9477). Among men, mean age at diagnosis decreased with increasing BMI at age 20 (p= 0.0125) (Table 1a) and at 5 years prior to diagnosis (p=0.0252) (Table 1b). Among women, the trend was signficant at age 20 (p=0.0018) (Table 1a) but not at 5 years prior to diagnosis (p= 0.7094) (Table 1b). Increasing BMI was not significantly associated with any other clinical characteristics.Table 1aAssociation of body mass index (BMI) at age 20 with age at diagnosis among African-American multiple myeloma patients.MenWomenTotalBody Mass Index (ht/wt2)NMean Age at DiagnosisNMean Age At DiagnosisNMean Age At Diagnosis< 2512160.723160.135260.425-306457.93257.49657.7> 301855.22352.944153.9Total203286489P for trendP= 0.0125P= 0.0018P<0.0001Table 1bAssociation of body mass index (BMI) at 5 years prior to age at diagnosis among African-American multiple myeloma patients.MenWomenTotalBody Mass Index (ht/wt2)NMean Age at DiagnosisNMean Age At DiagnosisNMean Age At Diagnosis< 254661.77859.312460.225-308859.79859.018659.3> 307757.412259.819958.9Total211298509P for trendP= 0.0252P= 0.7094P= 0.3063 Conclusion/DiscussionIn a large collection of African-American MM patients, we observed a strong association between increasing BMI at age 20 and younger age at diagnosis. A similar trend was observed in men only at 5 years prior to diagnosis, consistent with previous reports. Obesity is one of the few known potentially modifiable risk factors for MM. Younger age at diagnosis reflects an earlier accumulation of either or both genetic and environmental risk factors. Obesity at an early age may influence MM risk through shared biological pathways such as interleukin-6 and insulin-like growth factor, by contributing to chronic B-cell activation, thereby increasing susceptibilty for MM later in life. The significance of the gender difference for the association closer to diagnosis is unclear and requires additional study. Disclosures:Terebelo:Amgen: Honoraria; Millennium: Honoraria. Mehta:Celgene: Speakers Bureau; Millennium: Speakers Bureau. Zonder:Skyline: Consultancy. Orlowski:Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Millennium: The Takeda Oncology Company: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Onyx: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Resverlogix: Research Funding; Array Biopharma: Honoraria, Membership on an entity's Board of Directors or advisory committees; Genentech: Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Membership on an entity's Board of Directors or advisory committees. Lonial:Celgene Corporation: Consultancy; Millennium: Consultancy; Novartis: Consultancy; Bristol Myers Squibb: Consultancy; Sanofi: Consultancy; Onyx: Consultancy.

Abstract 2021: Characterization of myeloma tumors from a multi-ethnic cohort using cytogenetics and genomic analysis.

Abstract The plasma cell malignancy Multiple Myeloma (MM) is a rare but deadly form of cancer with 5 year survival rates of ∼30%. Epidemiological studies have suggested that MM exacts an especially heavy burden on African American (AA) patients. We examined a multi-ethnic cohort of MM tumors to assess potential differences in the frequency of molecular events in tumors derived from either African American (AA) or European American (EA) patients. The frequency of 14q32 translocation breakpoints at the IgH locus was compared among a series of data from 115 AA MM patients from three studies and EA MM from the Eastern Cooperative Oncology Group (ECOG). In addition, we analyzed matching genome-wide copy number and transcriptional data among 45 AA MM tumors and 196 EA MM tumors to determine differences in the frequency of molecular events in tumors from these populations. No differences were found for specific translocation subtypes; however, we detected a statistically significant difference in the overall frequency of IgH translocations between the two groups, which occurred more frequently in EA patients (52% vs. 40%; p = 0.032). When assessing genomic copy number events previously shown to be associated with poor outcome in MM, frequencies of alterations were not significant after correcting for multiple testing. Furthermore, there was not a significant difference in the association of high-risk disease using expression profiling. Our study represents the first comprehensive assessment of the frequency and distribution of molecular alterations in MM tumors from both AA and EA patients and could help shed light on possible biological features associated with population differences in incidence and outcome in MM. Citation Format: Angela S. Baker, Esteban Braggio, Susana Jacobus, Sungwon Jung, Dirk Larson, Terry Therneau, Angela Dispenzieri, Scott A. Van Wier, Gregory Ahmann, Joan Levy, Louise Perkins, Seungchan Kim, Kim Henderson, David Vesole, S. Vincent Rajkumar, Dianne F. Jelinek, John Carpten, Rafael Fonseca. Characterization of myeloma tumors from a multi-ethnic cohort using cytogenetics and genomic analysis. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2021. doi:10.1158/1538-7445.AM2013-2021

Abstract 5064: Cytogenetic and somatic characterization of myeloma tumors from a multi-ethnic cohort

Abstract Previous epidemiological studies have suggested that African Americans (AA) are twice as likely to be diagnosed with and to die from Multiple Myeloma (MM) as compared to European Americans (EA). In recent years, however, mortality rates have become more comparable between these groups. Although socioeconomic factors could play a major role to this potential disparity, biological factors may also be responsible for influencing these differences in either incidence and/or mortality. Here we examined a multi-ethnic cohort of MM tumors to assess potential differences in the frequency of molecular events in tumors derived from either African American (AA) or European American (EA) patients. First, we compared the frequency of 14q32 translocation breakpoints at the IgH locus among a series of data from 115 AA MM patients from three studies and EA MM from the Eastern Cooperative Oncology Group (ECOG). Furthermore, we analyzed matching genome-wide copy number and transcriptional data among 47 AA MM tumors and 196 EA MM tumors to determine differences in the frequency of molecular events in tumors from these populations. Univariate analyses were conducted using the Fisher's Exact Test and p-values were calculated to measure statistical significance. We observed statistically significant differences in the frequency of IgH translocations and somatic copy number alterations. Although we did not detect differences for specific translocation subtypes, we saw a statistically significant difference in the overall frequency of IgH translocations between the two groups, which occurred more frequently in EA patients (p = 0.032). When assessing genomic copy number events previously shown to be associated with poor outcome in MM, chromosome 13 monosomy was more frequent in hyperdiploid MM from AA patients and significant after correcting for multiple testing using the Bonferoni correction method (p = 0.001). Moreover, when using the Benjamini-Hochberg multiple testing correction method, chromosome 13 monosomy remained significantly different among hyperdiploid AA patients (p = 0.0121). Chromosome 1q amplification was also significant among hyperdiploid tumors from EA patients when using this correction method (p = 0.036). No differences in the frequency of hyperdiploid status or gene expression-based subtypes were detected when comparing tumors from AA and EA patients. Our study represents the first comprehensive assessment of the frequency and distribution of molecular alterations in MM tumors from both AA and EA patients and could help shed light on possible biological features associated with population differences in incidence and outcome in MM. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5064. doi:1538-7445.AM2012-5064

Improved Outcome of African American Multiple Myeloma Patients with Novel Agents and Autologous Stem Cell Transplant

Improved Outcome of African American Multiple Myeloma Patients with Novel Agents and Autologous Stem Cell Transplant

Survival Disparities Between African-American and Caucasian Patients Treated with Autologous Stem Cell Transplantation for Multiple Myeloma Are Eliminated in the Era of Novel Therapeutics

Abstract 2017 Background:Multiple myeloma (MM) remains an incurable disease and is the most common hematologic malignancy among African-Americans. In the United States, MM and its precursor monoclonal gammopathy of undetermined significance (MGUS) are twice as common in African Americans (Hari et al 2010). Analysis of the Surveillance Epidemiology and End Results (SEER) database from 1969 to 2003 demonstrated African-Americans have twice the mortality from MM compared to Caucasians. However this may be a function of the considerable difference in incidence of MM between Caucasian and African-American populations. Retrospective data from Southwest Oncology Group showed comparable outcomes between groups before the advent of autologous stem cell transplantation (auto-HCT). Recently Hari et al. determined that African-American and Caucasians have similar outcomes after auto-HCT for MM. In the age of novel therapy, Waxman et al addressed racial disparity in population based query of SEER and found disease specific survival was greater for African-Americans than Caucasians; and over time, survival improvement was much less pronounced among African-Americans than Caucasians. Nevertheless transplant specific data is sparse in the contemporary era with novel treatment options. Methods:We performed a retrospective review of 196 African-American multiple myeloma patients (pts) and 806 Caucasian patients initially seen at the M.D. Anderson Cancer Center from 1/1/2002 to 12/31/2010 who underwent autologous transplantation after high dose chemotherapy. The year 2002 was used to incorporate patients who had been exposed to novel agents. Results:A total of 1002 patients were analyzed, 196 African American and 806 Caucasian pts with multiple myeloma who underwent an autologous transplant. Median age at diagnosis was 59 years for both cohorts. Initial response prior to transplant was fairly evenly matched between groups (TABLE 1) as well as final response after transplant. 25% of Caucasian pts and 21% of African-American pts achieved a very good partial response (VGPR) while 28% of Caucasian and 21% of African-American pts achieved a complete response (CR). For evaluable patients, the International Staging System (ISS) at diagnosis was determined. The percentage of stage I, II and III patients in the African-American group was 27%, 20% and 17% respectively. The percentage of stage I, II and III patients in the Caucasian group was 26%, 19% and 17% respectively. Importantly 133/806 of Caucasians and 33/196 of African Americans were diagnosed at ISS stage III (p value=0.91). There was no measurable difference in progression free survival (figure 1) or overall survival (figure 1figure 2) with a maximum follow-up of >100 months.Table 1Caucasian (n = 806)African-American (n = 196)Median age at auto-HCT59 (31–80)59 (34–78)Age over 65 at auto-HCT178/806 (22%)26/196 (13%)Response prior to transplantPD = 46 (6%)PD = 13 (6%)SD = 68 (8%)SD = 12 (6%)MR = 29 (3. 5%)MR = 11 (6%)PR = 437 (54%)PR = 102 (52%)VGPR = 179 (23%)VGPR = 38 (19%)CR = 35 (4%)CR = 13 (7%)Untreated = 2 (0. 2%)Unknown = 7 (4%)Unknown = 10 (1. 3%)Median time from diagnosis to transplant237 days (51– 7985)238 days (83 – 6495)Final ResponsePD = 24 (3%)PD = 9 (5%)< PR = 90 (11%)< PR = 32 (16%)PR = 260 (32%)PR = 69 (35%)VGPR = 198 (25%)VGPR = 42 (21%)CR = 227 (28%)CR = 41 (21%)Unknown = 7 (1%)Unknown = 3 (2%)ISS scoreI = 210 (26%)I = 52 (27%)II = 157 (19%)II = 39 (20%)III = 133 (17%)III = 33 (17%)Unknown = 306 (38%)Unknown = 72 (36%)Median PFS36 months34 monthsMedian OS46 months48 monthsPD: progressive disease SD: stable disease MR: minimal response PR: partial responseVGPR: very good partial response CR: complete response [Display omitted] [Display omitted] Conclusion:In this retrospective single-center study we demonstrated no difference in progression free survival or overall survival between African-American and Caucasian patients with MM treated in the era of novel agents and autologous stem cell transplantation. These findings concur with previous studies showing no difference in response to treatment between racial groups. In light of older SEER data this may be an effect of novel agents, improved access of care for African Americans or a combination of both. Disclosures:No relevant conflicts of interest to declare.

Incidence of cytogenetic (CG) abnormalities in multiple myeloma (MM) in a minority population.

e18568 Background: Genomic aberrations are associated with MM survival and disease evolution. The combination of cytogenetics and Fluorescence in situ hybridization (FISH) reveals more anomalies than CG alone. The incidence of CG abnormalities in African American MM patients (AA) is not known. Methods: Records of patients with MM seen at Kings County Hospital and Downstate Medical Center from 2004 through 2010 were reviewed. Results: Of the 185 records reviewed, 181 (98%) patients had MM; 3 had plasma cell leukemia. Their age ranged from 36-89 years (median 66). There were 84 men (46%) and 97 women. CG analysis was done in 86 patients, 41 (48%) female and 45 (52%) male; of whom 82 were AA. CG was abnormal in 14 male and 6 female patients. Aneuploidy was present in 15 of 20 (75%); 11 of the 15 (73%) were hyperdiploid and 4 (26%) hypodiploid. Hyperdiploid chromosome number ranged from 49 to 67 (median 53). The most frequently aberrant chromosomes were 1, 4, 5 and 15. FISH was done in 42 patients for abnormal chromosomes 13, 14 and 17. One of 37 chromosomes 13 (2.6%), 3 of 28 (11%) chromosomes 14, and 1 of 14 (7.1%) chromosomes 17 displayed molecular abnormalities. In no case was more than one abnormality found. FISH on 28 patients with normal CG yielded only 1 (3.6%) abnormality. Conclusions: Abnormal CG was not more frequent in this AA population than in MM patients from other ethnic groups, but was in male AA patients. Fewer molecular abnormalities were found in this population.

Monoclonal Gammopathy of Undetermined Significance Versus Smoldering Myeloma: Is Active Surveillance Enough?

614. 22. www.leukemia-lymphoma.org. 23. Landgren O, Devesa S, Mink P, et al. African-American multiple myeloma patients have a better survival than Caucasian patients: a populationbased study including 28,636 patients [abstract 1832]. Proc Am Soc

African-American Multiple Myeloma Patients Exhibit Less Bone Disease Compared to Other Racial/Ethnic Groups

AbstractAbstract 4994 Background:Bone destruction remains one of the major complications in Multiple Myeloma (MM) leading to morbidity and mortality. African-Americans have a higher incidence of MM but exhibit longer survivals compared to Caucasians. We analyzed bone involvement in a cohort of patients with MM to determine if non African American (non AA) vs. African American (AA) race predicts the presence and severity of bone disease at presentation. Methods:Clinical data was gathered on 197 (176 non AA and 21 AA) MM patients at the University of California, San Francisco. Each patient had a skeletal survey at diagnosis and identified as having 0 lytic lesions, 1–2 lytic lesions or 3 or more lytic lesions. The presence of compression fractures was also documented for each patient as was age and sex. Results:The presence of compression fractures strongly correlated with the number of lytic lesions in both the non AA and AA groups, with no compression fractures observed in the patients with zero lytic lesions (p<0.001). Among the AA group, there were fewer (6 of 15) patients with compression fractures compared with patients from the non AA group (92 of 161) (p=0.02). There was also a trend towards fewer lytic lesions among the AA group (p=0.053). No significant difference was observed between the extent of bone disease and age or sex between the two groups. Conclusions:Within this cohort of patients, there is a significantly lower rate of compression fractures among African-Americans. These data supports the idea that African-American patients present with less bone disease which confers a survival advantage compared to other racial/ethnic groups. Disclosures:No relevant conflicts of interest to declare.

Survival Disparities Between African American and Caucasian Patients With Multiple Myeloma Are Blunted in the Era of Novel Therapeutics and Autologous Stem Cell Transplantation

Abstract Background Multiple myeloma (MM) accounts for approximately 10% of hematologic malignancies diagnosed annually in the United States. It is well documented that the African American population is disproportionately affected by MM in incidence and mortality. Survival data from the SEER database from 2001-2005 demonstrated higher mortality in African American patients compared to Caucasian patients. However, more recent retrospective reviews in the era of autologous stem cell transplantation (ASCT) did not support this finding. Thus the persistence of racial survival disparities in the era of ASCT and novel therapeutic agents is an evolving question. Patients and Methods We performed a retrospective review of 170 African American MM patients and 170 age-matched and gender-matched Caucasian patients initially seen at the M. D. Anderson Cancer Center from 1/1/2002 to 12/31/2008. Results Three hundred forty previously untreated patients were analyzed. Median age at diagnosis was 57 years for both groups. For evaluable patients, the International Staging System at diagnosis was determined. The percentage of stage I, II, and III patients in the African American group was 53%, 28%, and 19%, respectively. The percentage of stage I, II, and III patients in the Caucasian group was 40%, 30%, and 29%, respectively. These staging data were not significantly different between racial groups. In both groups, 89% of patients received a novel therapeutic agent (thalidomide, lenalidomide, or bortezomib) during their treatment course. We found a statistically significant difference in the percentage of African American and Caucasian patients who received high-dose chemotherapy and ASCT (65% and 76%, respectively; P = .04). There was no difference observed in the number of second transplantations performed in the two groups (19 in both groups). Response to therapy is detailed in Table 1 . There was no difference in overall response to any therapy of evaluable patients between the two groups. With a median follow-up time of 35 months, the median overall survival from diagnosis has not been reached in either group. Kaplan-Meir analysis shows that there is no difference in overall survival between African American and Caucasian patients (P = .1) Conclusion In this single-center, retrospective study of MM patients treated predominately with novel agents, with or without ASCT, no survival difference was observed between African American and Caucasian patients. To our knowledge, this is the largest number of African American myeloma patients analyzed for survival in a single-center study. Recognizing the potential disparities in healthcare access, this may not represent outcomes for all African American patients with myeloma. Since median overall survival has not been reached in this data, it is possible that survival differences will become apparent in the future, and further follow-up is needed. However, this review suggests that in the era of novel therapeutics and ASCT resulting in improved overall response rates, survival in African American patients may be equivalent to Caucasian patients. Further efforts are needed to enroll African American patients on clinical trials to validate this observation prospectively. Abstract 6 - Table 1 . Best Response to Any Therapy Race CR VGPR PR ORR African American 56/154 (36%) 15/154 (10%) 76/154 (49%) 147/154 (95%) Caucasian 57/162 (35%) 32/162 (20%) 64/162 (40%) 153/162 (94%)

Abstract 4822: Analysis of somatic copy number alterations associated with poor prognosis and progression of multiple myeloma in African Americans

Abstract The plasma cell malignancy Multiple Myeloma (MM) is a rare but deadly form of cancer with 5 year survival rates of ∼30%. The disease exacts an especially heavy burden on African American (AA) patients. In fact, African Americans are twice a likely to be diagnosed with and die from MM as compared to Caucasian Americans. Although socio-economic factors likely influence this disparity, the role of biology has not been ruled out. We have profiled ∼250 MM tumors for somatic copy number alterations using array-based Comparative Genomic Hybridization (aCGH) and Gene Expression Profiling as part of the Multiple Myeloma Genomics Initiative. To determine if somatic alterations may play a role in the disparity in incidence and/or severity of MM in AA, we compared the frequency of specific chromosomal aberrations in genes and genomic regions previously found to be involved in progression and poor outcome in MM among a cohort of one hundred ninety-six (196) patients including 16 African Americans and 180 Caucasians. The frequency of occurrence (expressed as a percentage) was determined for each of the following aberrations: 1p deletion, homozygous deletion of p18, chromosome 13 deletion, and chromosome 13 monosomy. No significant difference was detected in the frequency of chromosome 13 deletion and chromosome 13 monosomy between the two groups. However, significant differences were observed for chromosome 1p alterations. Homozygous deletion at the p18 locus at 1p occurred in 12.5% (2/16) of tumors from AA patients and 2.8% (5/180) of CA patient tumors (p = 0.045). We further stratified tumors by hyperdiploid or non-hyperdiploid status using a-CGH profiles to determine ploidy status. Most significantly, p18 homozygous deletion was found in 25% (2/8) of AA patients with non-hyperdiploid tumors and in only 1.2% (1/83) of CA patients with non-hyperdiploid tumors (p=3.2 × 10-4). A nominally significant difference among non-hyperdiploid patients was also present for overall 1p deletion, which was observed in 2/8 (25%) of AA non-hyperdiploid tumors and 33/83 (40%) of CA with non-hyperdiploid tumors (p=0.05). No differences were observed for 1p deletion or p18 homozygous deletion among hyperdiploid tumors between AA and CA patients. These results suggest that deletions at 1p are more common among African American MM patients. Furthermore, homozygous deletion encompassing the p18 locus is more significantly common among AA MM patients, especially AA patients with non-hyperdiploid tumors. As 1p deletion and p18 homozygous deletion have been linked to poor outcome, our results suggest that the increased frequency of these alterations in tumors from AA patients may in part explain the disparity in unfavorable outcomes seen among AA MM patients Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4822.

African-American Multiple Myeloma Patients Have a Better Survival Than Caucasian Patients: a Population-Based Study Including 28,636 Patients.

Abstract 1832Poster Board I-858 BackgroundMultiple myeloma is the most common hematologic malignancy in African-Americans with twice the incidence of Caucasians. Prior single center studies have reported poorer survival among African-American multiple myeloma patients. In contrast, recent data based on multiple myeloma patients who received autologous transplantation in an equal access health care system, showed comparable survival between African-Americans and Caucasians, suggesting that the reportedly poorer outcome for African-Americans may be due to inequalities in access to care. Also, based on publicly available cancer registry data, several publications have reported excess mortality rates for African-American multiple myeloma patients. We conducted a large population-based study including almost 30,000 multiple myeloma patients to evaluate survival patterns by race. Methods. Patient information was obtained from the Surveillance, Epidemiology and End Results (SEER) cancer registries of the National Cancer Institute. Data were drawn from the original nine SEER registries (Atlanta, Connecticut, Detroit, Hawaii, Iowa, New Mexico, San Francisco-Oakland, Seattle-Puget Sound, and Utah), which collectively cover approximately 10% of the U.S. population. Using the SEER*Stat statistical software package, we calculated 1-, 5-, and 10-year relative survival rates (RSR) of multiple myeloma patients diagnosed 1973-2004. We applied four calendar periods (1973-1979, 1980-1986, 1987-1993, and 1994-2004), follow-up through 2005 was included, and age at diagnosis was grouped into three strata (<50, 50-64, and 65+ years). ResultsWe identified a total of 28,636 multiple myeloma patients (4,855 African-American; 23,781 Caucasian); 64% were 65 years or greater at diagnosis. When we included all patients, a comparison of survival rates in African-American and Caucasian males showed that African-American males had significantly better 5-year (32.2% vs. 28.7%) and 10-year (16.4% vs. 11.5%) RSRs (p<0.05). Similarly, African-American females had significantly better 1-year (73.3% vs. 70.2%) and 5-year (31.1% vs. 27.7%) RSRs than Caucasian females (p<0.05). When we examined survival patterns by calendar period (between 1973-1979 and 1994-2004), we found Caucasian patients to have significant improvements in the 1-year (from 67.1 to 72.4%), 5-year (from 24.1% to 31.7%), and 10-year RSR (from 9.9% to 14.9%). African-Americans also showed significantly improved 1-year RSRs (from 68.5% in 1973-1979 to 74.9% in 1994-2004) but the improvements in 5- and 10-year RSRs were not significant. When we examined survival patterns by age group, in the youngest age group (<50 years), both African-Americans and Caucasians improved 5- and 10-year RSRs, while 1-year RSR was improved for Caucasians only (from 80.9% to 84.9%). For patients 50-64 years, Caucasians had significantly improved 1-, 5-, and 10-year RSR; for African-Americans only 1-year RSR improvement was significant. Among patients 65+, there was no significant improved survival for African-Americans while Caucasians had improved 1-year (from 61.4% to 66.9%) and 5-year (from 19.6% to 24.7%) RSRs. ConclusionsThis large study of almost 30,000 patients found African-American multiple myeloma patients to have a significantly better prognosis than Caucasian patients, suggesting there is disease heterogeneity by race. After the introduction of newer therapies (autologous transplant, IMiDs, and bortezomib), Caucasian multiple myeloma patients showed a more pronounced survival benefit which might reflect inequalities in access to modern care; however, still African-Americans showed similar/better survival compared to Caucasians. Clinicians should be aware that the excess mortality rates for multiple myeloma among African-Americans, to a major degree, is a reflection of the fact that multiple myeloma is 2- to 3-fold more common among African-Americans. Future studies are needed to improve our understanding of the molecular basis for racial disparity patterns in multiple myeloma. Ultimately, such efforts will facilitate an improved understanding regarding disease subtype-specific benefits for individual agents, as well as mechanistic insights into drug sensitivity and resistance. DisclosuresWeiss:The Binding Site, Inc.: Research Funding.

Survival Disparities Between African-American and Caucasian Patients with Multiple Myeloma Are Blunted in the Era of Novel Therapeutics and Autologous Stem Cell Transplantation.

Abstract 1395Poster Board I-417 Background:Multiple myeloma accounts for approximately 10% of hematologic malignancies diagnosed annually in the U.S. It is well documented that the African-American population is disproportionately affected by multiple myeloma in incidence and mortality. Survival data from the SEER database from 2001-2005 demonstrated higher mortality in African-American patients compared to Caucasian patients. However, more recent retrospective reviews in the era of autologous stem cell transplant (ASCT) did not support this finding. Thus the persistence of racial survival disparities in the era of ASCT and novel therapeutics is an evolving question. Methods:We performed a retrospective review of 170 African-American multiple myeloma patients and 170 age and gender-matched Caucasian patients initially seen at the M.D. Anderson Cancer Center from 1/1/2002 to 12/31/2008. Results:Three hundred forty previously untreated patients were analyzed. Median age at diagnosis was 57 years for both groups. For evaluable patients, the International Staging System at diagnosis was determined. The percentage of stage I, II and III patients in the African-American group was 53%, 28% and 19% respectively. The percentage of stage I, II and III patients in the Caucasian group was 40%, 30% and 29% respectively. These staging data were not significantly different between racial groups. In both groups, 89% of patients received a novel therapeutic (thalidomide, lenalidomide or bortezomib) during their treatment course. We found a statistically significant difference in the percentage of African-American and Caucasian patients who received high dose chemotherapy and ASCT (65% and 76%, respectively, p=0.04). There was no difference observed in the number of second transplants performed in the two groups (19 in both groups). Response to therapy is detailed in Table 1. There was no difference in overall response to any therapy of evaluable patients between the two groups. With a median follow-up time of 35 months, the median overall survival from diagnosis has not been reached in either group. Kaplan-Meir analysis shows that there is no difference in overall survival between black and white patients (p =0.1) Conclusions:In this single-center, retrospective study of multiple myeloma patients treated predominately with novel agents, with or without ASCT, no survival difference was observed between African-American and Caucasian patients. To our knowledge, this is the largest number of African-American myeloma patients analyzed for survival in a single-center study. Recognizing the potential disparities in healthcare access, this may not represent outcomes for all African-American patients with myeloma. Since median overall survival has not been reached in this data, it is possible that survival differences will become apparent in the future, and further follow-up is needed. However, this review suggests that in the era of novel therapeutics and ASCT resulting in improved overall response rates, survival in African-American patients may be equivalent to Caucasian patients. Further efforts are needed to enroll African-American patients on clinical trials to validate this observation prospectively.Table 1Best Responses to Any TherapyRaceCRVGPRPRORRAfrican-American56/154 (36%)15/154 (10%)76/154 (49%)147/154 (95%)Caucasian57/162 (35%)32/162 (20%)64/162 (40%)153/162 (94%) Disclosures:No relevant conflicts of interest to declare.