Introduction: There have been major advances in the diagnosis, staging, risk-stratification, and management of multiple myeloma (MM). Novel triplet regimens containing drugs such as Carfilzomib, Elotuzumab, Daratumumab, or Ixazomib have improved the median progression-free survival rates at first relapse to approximately two years. This retrospective study analyzes the responses and survivals of treatment regimens used at first relapse in the real world setting and attempts to evaluate any differences in outcomes based on race. Methods: We reviewed the charts of all patients with relapsed/refractory or progressive multiple myeloma who were treated for first relapse or progression at Henry Ford Hospital in Michigan. Patients who received a combination regimen with any of the following medications: Bortezomib, Lenalidomide, Pomalidomide, Ixazomib, Carfilzomib, Daratumumab, and Elotuzumab between 1/1/2015 and 4/24/2018 were included. Baseline characteristics data using the electronic medical record was retrieved for age, sex, race, performance status, cytogenetics, previous treatment, progression free survival and compared based on race. Patients were excluded if they did not receive treatment for relapse, expired prior to initiating relapse treatment or were lost to follow up. Results: A total of 300 patients were treated with systemic therapy for multiple myeloma, 140 of whom had relapsed/refractory or progressive disease. We excluded 28 patients who did not meet inclusion criteria. The remaining 112 patients were treated for first relapse or progression of myeloma and were included in our study cohort. Patients characteristics are shown in table 1. Out of those 112 patients, 26 (23.2% of the cohort) received a novel triplet regimen for their first relapse, 21 (18.8%) received an older triplet regimen, 14 (12.5%) received a novel doublet regimen, 44 (39.3%) received an older doublet regimen and the remainder 7 patients (6.3%) received other regimens as detailed in table 2. Of the 26 patients who received a novel triplet regimen, 11 were African American and 15 were White. Ten patients had disease progression or death at the time of data analysis and qualified for progression free survival (PFS) calculation. The remaining 16 patients were still receiving their treatment regimen at the time of analysis. Progression free survivals comparing novel triplet regimens based on patients race are shown in table 2. Of note, median PFS for Carfilzomib, lenalidomide, dexamethasone (KRd) regimen was 26.3 months in the ASPIRE trial and 20.6 months for Ixazomib, lenalidomide, dexamethasone regimen in the TOURMALINE-MM1 trial. The 12-month rate of PFS for Daratumumab, bortezomib, dexamethasone (DVd) regimen was 60.7% in the CASTOR trial, 83.2% for Daratumumab, lenalidomide, dexamethasone (DRd) regimen in the POLLUX trial and 68% for Elotuzumab, lenalidomide, dexamethasone regimen in the ELOQUENT-2 trial. Of the 21 patients who received an older triplet regimen, 9 were African American, 11 were White and 1 was Hispanic. All of them had disease progression or death and qualified for PFS calculation. Of the 44 patients who received an older doublet regimen, 27 were African American, 15 were White and 2 were Hispanic. Thirty two patients had disease progression or death at the time of data analysis. Of the 14 patients who received a novel doublet regimen, 9 were African American and 5 were White. Eight had disease progression or death at the time of data analysis. These results are shown in table 2. Conclusion: Our retrospective cohort study shows a distribution of the treatment regimens used for the management of relapsed multiple myeloma. Progression free survivals for a novel triple drug regimen for myeloma at first relapse seems to be shorter in the real world setting than published data. Specifically, when compared based on race, African American patients had worse outcome overall with shorter progression free survival period. However, data is limited due to the small number of patients. Stratification based on race or focused trials for certain populations such as African American are needed to manage this challenging disease. Disclosures No relevant conflicts of interest to declare.

Background: Thrombocytopenia is a frequently encountered laboratory abnormality and a common reason for hematology referrals. Workup for thrombocytopenia is not standardized and frequently does not follow an evidence-based algorithm. We conducted a systematic analysis to evaluate the laboratory testing and outcomes of patients evaluated for thrombocytopenia at hematology clinics in a tertiary referral center between 2013 and 2016. Patient and methods: We performed a comprehensive chart review for patients evaluated for thrombocytopenia during the study period. Patients were followed for 1 year from the initial hematology evaluation and assessed for the development of a hematologic malignancy, rheumatologic, or infectious diseases among other clinical outcomes. Results: We evaluated 472 patients with a median (range) age of 61 (17–94) years. The majority (63.8%) had mild thrombocytopenia. Within 1 year of follow-up, 14 patients (3.0%) were diagnosed with a hematologic malignancy. A higher likelihood of developing a hematologic malignancy was noted in patients with concurrent leukopenia (hazard ratio [HR] 9.97, 95% confidence interval [CI] 3.28–30.32, p < .01) and increasing age (HR per 10-year deciles 1.52, 95% CI 1.03–2.25, p = .03). In patients with asymptomatic isolated mild thrombocytopenia, laboratory testing did not reveal any significant positive findings and patients did not receive any new major diagnosis during the follow-up period. Conclusion: Our findings provide basis and call for development of an evidence-based algorithmic approach for evaluation of patients with thrombocytopenia, testing, and referrals. It also supports a conservative approach mainly driven by physical exam signs, symptoms, and other laboratory findings for patients with isolated mild thrombocytopenia.

e20504 Background: Multiple Myeloma (MM) accounts for about 17% of hematologic malignancies in the United States. It is a disease of older adults, with a median age at diagnosis of 66 years. The incidence in African Americans is 2 to 3 times more that in Whites, and this disparity has been found to be greater among patients less than 50 years. Most guidelines recommend induction therapy with a triplet regimen followed by autologous hematopoietic cell transplantation (HCT). Unfortunately, racial and ethnic minorities have been found to be less likely to receive ASCT. A SEER-Medicare database analysis from 2000 to 2011 noted a lower utilization of ASCT and Bortezomib among black patients. The goal of this study was to evaluate patterns of acceptance of ASCT as consolidative therapy of MM. Because the receipt of upfront ASCT is dependent on response to induction therapy, our study also investigated disparity in transplant outcomes and time to transplant, which are areas that previous studies had not looked at. Methods: In this retrospective review we used Cox PH model to investigate the association between the survival time of the patients (OS) and age of the diagnosis, race, socioeconomic status, disease cytogenetic, and initial induction regimens. 194 patients with a confirmed diagnosis of MM who were referred for autologous hematopoietic stem cell transplantation (ASCT) between January 1st 2009 and June 30st 2019 were included in this study. Patients who received ASCT for relapsed MM were excluded. Results: Using Cox PH model, we found that high risk cytogenetic were significantly associated with shorter overall survival, higher transplant related mortality and relapse related mortality (P < 0.002). Use of aggressive induction choices was associated with poorer transplant outcomes (P 0.02). Time to transplant tended to be shorter in African American compared to other ethnic groups (P 0.07). Income category was not significantly associated with overall survival, time to transplant or transplant / relapse related mortality. Conclusions: Cytogenetic continues to be a significant factor in transplant outcomes affecting overall survival. Time to transplant tended to be shorter in African American comparing to others, potentially reflecting the differences in disease course. Our study provides a more real life data on ASCT outcome patterns. It is hoped that the results of this study will better guide interventions to improve utilization of ASCT as consolidative therapy for MM.