Lenalidomide is indicated in the front-line management of multiple myeloma. More recently, it has been introduced for use in treating other hematologic malignancies. Although the drug is known to cause myelosuppression, there have been rare reports of lenalidomide-associated immune thrombocytopenia (ITP). Here, we review the literature on lenalidomide-associated ITP and report upon a 59-year-old man who was administered lenalidomide due to concern of progressive multiple myeloma more than a year following his having undergone an autologous hematopoietic stem cell transplant. His platelet count precipitously declined and lead to his hospitalization. Despite our withholding of the drug, he did not respond to platelet transfusions or administration of corticosteroids. He was successfully managed with intermittent immune globulin for several months before definitive treatment with splenectomy, which resulted in the complete resolution of his thrombocytopenia. A literature search identified a total of six additional cases of lenalidomide-associated ITP. Similarly, many of the reported cases were associated with persistent thrombocytopenia after discontinuation of the drug. Furthermore, these patients were generally managed successfully with standard ITP therapies, such as corticosteroids or intravenous immune globulin.

Background: Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm which is associated with an increased risk of thrombohemorrhagic complications as well as progression to myelofibrosis and frank leukemia. Patients with ET are at an elevated risk for stroke. However, studies of prevalence and outcomes of stroke in hospitalized patients with ET have been limited to case series. The median survival of patients with ET is comparable to normal population but the quality of life may be significantly altered due to the occurrence of thrombotic events in the cerebrovascular and cardiovascular systems. By conducting a retrospective analysis of nationwide data from hospitalized ET patients between the years of 2006 and 2014, we sought to identify if there are any statistically significant associations between stroke and/or in-hospital mortality with respect to patients' gender, age group, race, and comorbidities like hypertension, diabetes atrial fibrillation and chronic kidney disease. Methods: Data from the National Inpatient Sample was utilized to identify outcomes in hospitalized patient with ET who were admitted for stroke. The National Inpatient sample is a database maintained by the Agency for Healthcare Quality and Research. Utilizing the current procedural terminology code (CPT) for ET, outcomes of patients with ET who were hospitalized with stroke were studied for the year 2006 to 2014. Patient demographics of age, gender and race were collected and hospital characteristics of location and size were correlated to outcomes. The extent of common medical comorbidities such as hypertension, diabetes, chronic kidney disease and atrial fibrillation was studied in ET patients who died with and without stroke. Chi square test was used to determine odds ratios and multiple logistic regression was used to determine independent predictors of mortality. Results: Between 2006 to 2014, 552422 hospitalizations involved patients with a diagnosis of ET of which 20650 hospitalizations were due to stroke. Of these patients with stroke there was a preponderance of prevalence in females (13400 vs. 7251). The percentage of stroke in these hospitalizations varied between 3.64 to 4.29 over 15 years and mortality in these patients did not significantly change during this time period. The prevalence of stroke was highest amongst Asians and Caucasians (4.7% and 3.86%) with a statistically significant difference (p=0.0000). The age group of 80+ years and the difference in prevalence between different age groups (18-34 vs. 35-49 vs, 50-64 vs. 75-79) was statistically significant (p=0.0000) with Medicare being the insurance for most of these patients (p=0.000)). Notably, mortality was highest in the same group but was not significantly different from other age groups. Large sized hospitals were noted to have a higher proportion of ET patients with stroke compared to smaller and medium sized hospitals (p=0.0002). No difference in such proportions was noted in hospitals varying by region (Northeast vs. Midwest vs. South vs. West). Burden of medical comorbidities as measured by Charlson's comorbidity index was noted to be in the 4-6 range. Similarly, hypertension, hyperlipidemia, diabetes, atrial fibrillation, smoking status were also found to be more frequent in ET patients with stroke. A majority of ET patients with stroke were discharged to skilled nursing facilities. Multiple regression showed that female gender, atrial fibrillation, stroke, higher Charlsons comorbidity score and 80+ age were independent predictors of mortality (OR: 0.75, 1.35, 1.8, 2 to 5.7, 13.9 respectively). Conclusions: Patients with ET who are hospitalized with stroke have significantly worse outcomes. This study demonstrated that a statistically significant difference exists among different age groups of patients with ET and stoke who died during hospitalization when stratification is made using age groups and Charlson Score. This study may serve as an initial point to include new risk factors for further risk stratification. Early identification of patients at higher risk may reduce the incidence and decrease the morbidity of stroke in patients with ET. Disclosures Kota: BMS: Honoraria; Novartis: Honoraria; Xcenda: Honoraria; Incyte: Honoraria; Pfizer: Honoraria.

e19055 Background: Socioeconomic disparities in healthcare have been well documented in America, with cancer being a critical area. One in four deaths are caused by cancer, and the effects on different communities are not equal. Clinical observations suggest that poorer socioeconomic circumstances lead to more frequent, later stage diagnoses and worse outcomes. The aim of this project was to quantify the sociodemographic and geographic contributions to disparities in advanced, metastatic breast cancer within the Augusta population and surrounding areas. Methods: Records of patients managed for breast cancer at the Georgia Cancer Center between Jan 2009- Jun 2019 were reviewed. 80 patients who presented with early stage breast cancer (clinical stage I) without positive lymph nodes were compared with 80 patients who presented with advanced, metastatic disease (clinical stage III-IV). Their race, breast cancer characteristics, insurance status, geographic proximity to a mammography site or major healthcare facility, and time interval between diagnosis and treatment were compared. Results: Results show that 73.75% early stage patients had private insurance, while 41.25% late stage patients had private insurance (p value < 0.0001). The early stage patients were 4.0 times more likely to have private insurance than late stage patients. Results also show that 25.0% of late stage patients had annual mammography screenings, while 77.78% of early stage patients had regular screening for mammograms (p value < 0.0001). The late stage patients were 1/10 as likely to have regular screening for mammogram as early stage patients. 80.6% of patients that received regular mammograms had private insurance, while the remaining 19.4% of those patients had public insurance. No statistical difference was shown in late and early stage presentation based on HER2 and/or triple negative (ER-, PR-, HER2-) status. Conclusions: There is a significant outcome of advanced, metastatic breast cancer in patients that do not have private insurance and in those that do not receive regular mammograms. Our findings support the importance of investing resources into alleviating differences in various socioeconomic populations as they relate to the amount and quality of cancer healthcare available. While the incidence of mortality in breast cancer is decreasing nationwide, disparities in morbidity and mortality will most likely continue unless there is an aggressive effort towards addressing said differences.

Background: Gastrointestinal stromal tumors are rare in pregnancy, and typically present in the second trimester with sizegreater-than-dates, abdominal pain, or nonspecific symptoms.Case: A 31-year-old gravida 1 female presented in the postpartum period with weight loss, cachexia, an abdominal mass, and persistent unexplained tachycardia. She was found to have a recurrent metastatic gastrointestinal stromal tumor and pulmonary emboli. She was anticoagulated and treated with neoadjuvant imatinib therapy with excellent initial response. Unfortunately, she died one year later due to complications of her disease and treatment. Conclusion:Malignancy should be considered in a pregnant woman with size-greater-than-dates or with an abdominal mass, especially when associated with unexplained weight loss and a history of a gastrointestinal stromal tumor, as the recurrence rate is high without continued maintenance therapy. Delivery at 35 to 37 weeks is recommended, and involvement of a multidisciplinary team improves outcomes.

134 Background: Socioeconomic disparities in healthcare have been well documented in America, with cancer being a critical area. One in four deaths are caused by cancer, and the effects on different communities are not equal. Clinical observations suggest that poorer socioeconomic circumstances lead to more frequent, later stage diagnoses and worse outcomes. The aim of this project was to quantify the sociodemographic and geographic contributions to disparities in advanced, metastatic breast cancer within the Augusta population and surrounding areas. Methods: Records of patients managed for breast cancer at the Georgia Cancer Center between Jan 2009- Jun 2019 were reviewed. 80 patients who presented with early stage breast cancer (clinical stage I) without positive lymph nodes were compared with 80 patients who presented with advanced, metastatic disease (clinical stage III-IV). Their race, breast cancer characteristics, insurance status, geographic proximity to a mammography site or major healthcare facility, and time interval between diagnosis and treatment were compared. Results: Results show that 73.75% early stage patients had private insurance, while 41.25% late stage patients had private insurance (p value < 0.0001). Results also show that 25.0% of late stage patients had annual mammography screenings, while 77.78% of early stage patients had regular screening for mammograms (p value < 0.0001). 80.6% of patients that received regular mammograms had private insurance, while the remaining 19.4% of those patients had public insurance. No statistical difference was shown in late and early stage presentation based on HER2 and/or triple negative (ER-, PR-, HER2-) status. Conclusions: There is a significant outcome of advanced, metastatic breast cancer in patients that do not have private insurance and in those that do not receive regular mammograms. Our findings support the importance of investing resources into alleviating differences in various socioeconomic populations as they relate to the amount and quality of cancer healthcare available. While the incidence of mortality in breast cancer is decreasing nationwide, disparities in morbidity and mortality will most likely continue unless there is an aggressive effort towards addressing said differences.