ALBERT

Description: Background: The myelodysplastic syndromes (MDS) encompass a heterogeneous group of hematopoietic stem cell disorders characterized by dysplastic and ineffective blood cell production leading to cytopenia and a variable risk of transformation to acute myeloid leukemia. The natural history of patients (pts) with MDS is variable and several prognostic scoring systems have been developed to guide treatment decisions. The revised IPSS (IPSS-R) score is commonly used in practice to predict outcome in newly diagnosed pts as well as in predicting their transplant outcomes. It remains unclear however whether improving IPSS-R pre allogeneic transplant (allo-SCT), using different therapeutic strategies, is associated with better clinical outcomes post-transplant. Methods: The Leukemia/BMT Program of British Columbia database was queried to identify all pts with MDS who had undergone an allo-SCT between Feb 1997 and April 2013. Pertinent information on clinical features and outcomes were then retrospectively reviewed. IPSS-R was calculated at MDS diagnosis (dx) and then re calculated prior to transplant. Outcomes of pts who had improvement in IPSS-R were then compared to those with no improvement or worsened IPSS-R score. Overall survival (OS) and Event free survival (EFS) were estimated using the Kaplan-Meier method and a competing risk analysis was used to calculate relapse and non-relapse mortality (NRM). Univariate and multivariate analyses were conducted. Log-Rank test was used to determine the p value. Results: We identified 138 pts who have undergone allo-SCT with the following characteristics: median age at transplant was 49 years (yrs) (range 17-66); 76 (55%) were male; 121 pts (88%) underwent myeloablative (MA) conditioning, 68 (49%) related donor and 70 (51%) unrelated donors out of which 43 (61%) were matched and 27 (39%) were mismatched. The source of stem cells were: peripheral blood n=101 (73%), bone marrow n=35 (25%) and cord blood n=2 (1%). The median interval from dx to transplant was 128 days. The median follow up (FU) of live pts was 7.3 yrs (range 1.5-17.4). Acute graft vs. host disease (aGVHD) grade 2 or higher was present in 74 (54%), chronic graft vs. host disease (cGVHD) was present in 94 (68%). During the time of FU 83 (60%) of pts had died. Relapse occurred in 41 (30%). Causes of death were: relapse n=39; GVHD n=20; regimen related n=11; infection n=5 and other causes, n=9. Baseline characteristics of all pts are shown in table 1. In 12 (9%) pts, the IPSS-R could not be calculated either because cytogenetics failed or bone marrow biopsy pre transplant was not done. At the time of transplant 85 (62%) pts had blasts 20% and blasts count was unknown in 5 pts. IPSS-R improved in 62 (45%), worsened in 23 (17%), no change 41 (30%) and unknown in 12 (9%). Type of treatment was chemotherapy in 55 (40%), best supportive care in 80 (58%) and immunosuppressive therapy (IST) in 3 (2%). The OS and EFS for all pts were 34% and 33%, respectively. There was no difference in outcome between pts who have undergone MA vs non-MA, OS 34% and 39% (p=0.63) and EFS 34% and 32% (p=0.86), respectively. OS was not statistically different between pts with improved IPSS-R vs worsened vs unchanged, 30% vs 22% vs 40%, p= 0.63 (see figure 1). EFS was 30% vs 21% vs 40%, p=0.53, respectively. Relapse was 36% vs 53% vs 31%, p=0.35 and non-relapse mortality was 54% vs 57% vs 42%, p=0.75, respectively. There was no difference in OS and EFS between pts treated with chemotherapy vs supportive care with OS of 40% vs 41%, p=0.63 and EFS of 33% vs 32%, p=0.46, respectively. OS and EFS for grade 2 or higher aGVHD were 34% vs 32%, p=0.13 and 32% vs 32%, p=0.22, respectively. Figure 2 shows OS for Pts with blast 20% at transplant. Relapse of pts with blasts 20 at the time of transplant was 23% vs 69% vs 66%, p=0.0004, respectively. On multivariate analysis, only three factors were associated with worse OS and EFS which were: cytogenetics at dx, blast count at transplant and absence of cGVHD. Conclusion: Improving IPSS-R before allogeneic transplant does not translate into better clinical outcome. The IPSS-R cytogenetic risk group at the time of diagnosis and blast count at transplant are highly predictive of post-transplant outcomes. Patient characteristics Patient characteristics Disclosures Gerrie: Roche Canada: Research Funding. Toze:Roche Canada: Research Funding. Song:Janssen: Honoraria; Otsuka: Honoraria; Celgene: Honoraria, Research Funding. Song:Janssen: Honoraria; Otsuka: Honoraria; Celgene: Honoraria, Research Funding. Nevill:Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Alexion: 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.

Description: Introduction In recent decades, overall survival rates for children with acute lymphoblastic leukemia (ALL) have improved dramatically. Unfortunately, older patients have not experienced the same benefit. Recent years have seen investigation into the use of pediatric protocols for younger adults with ALL. Increased toxicity has often limited use to patients 40 years or younger. The Leukemia/Bone Marrow Transplant Program of BC is the referral center for adults with ALL in British Columbia. Approximately 20 patients are newly diagnosed with ALL each year. Until 2008, an adult protocol (known as ALL 89-1) was used in patients over 18 years. Since 2008, pediatric-based chemotherapy has been offered to patients 40 years or younger. We analyzed whether this change altered complete remission (CR), relapse and survival rates. We assessed whether the more intense protocol increased toxicity. Methods A retrospective analysis was performed on patients treated for ALL on a pediatric-based protocol. These protocols (ALL 08-01 and ALL 13-01) were modifications of the Donna Farber Cancer Institute 01-175 protocol. The format included induction with high dose methotrexate, followed by central nervous system (CNS) therapy including cranial irradiation. A single cycle of etoposide and high-dose cytarabine was given. Consolidation and continuation cycles included doxorubicin, asparaginase, vincristine and dexamethasone. Patients were included if they were aged 18-40 years and had standard risk, Philadelphia chromosome negative ALL. Between February 2008 and November 2014, 25 eligible patients were identified. These were compared with the 23 consecutive standard risk patients most recently treated with ALL 89-1. They had been diagnosed between February 2003 and July 2008. Exclusion criteria were age greater than 40 and non-standard risk ALL. Demographic and clinical data were collected on all patients from the Leukemia Program databases. Overall survival (OS) was calculated from time of diagnosis until death. Event free survival (EFS) was calculated from diagnosis until death, induction failure or relapse. Estimation of OS and EFS was performed using the Kaplan-Meier method. Patient characteristics were compared using Chi-squared test or Fisher's exact test. Ethics approval was obtained from the University of British Columbia ethics board. Results The median age of the combined patient group was 24.5 years. There were no statistically significant differences pre-treatment between groups. Combined median follow up was 28.7 months All 25 patients receiving a pediatric protocol achieved a CR, compared to 19 of 22 with the adult protocol. Despite the more intense chemotherapy dosing regimen in the pediatric protocol, there was no increase in hospitalizations, invasive fungal infections or deaths from treatment toxicity (Table 1). There was a trend towards increased thrombotic events in the pediatric-treated group, at 32% versus 9%. These included deep vein thrombosis in 4 patients, pulmonary emboli in 2, and cerebral sinus thrombosis in 2. Relapse occurred in 24% of the pediatric-treated patients and 45% of the adult-treated ones (p=0.215). Allogeneic stem cell transplantation was performed in 4 patients in the former group and 7 in the latter. Nine of these were carried out in CR2 or later, with two patients going into transplant with active disease. Overall survival following transplant was 44%. Two year event free survival was significantly improved in the group treated on the pediatric protocol (Figure 1), at 79% versus 36% (p=0.011). There was a trend towards improved overall survival in this small cohort, at 83% versus 49% (Figure 2). Conclusions A pediatric-based ALL treatment protocol was tolerated in patients up to the age of 40 years. In our centre, this is associated with an increase in EFS, and a trend towards increased OS, even considering the small cohort. We await with interest the results of larger studies investigating the ideal upfront therapy for young patients with ALL. Table 1. Results All Patients N=47 Adult N=22 Pediatric N=25 P Number % Number % Number % CR after induction 44 of 47 94 19 of 22 86 25 of 25 100 .095 Severe infection 20 of 47 43 9 of 22 41 11 of 25 44 .831 Thrombosis 10 of 47 21 2 of 22 9 8 of 25 32 .079 Pancreatitis 2 of 47 4 0 of 22 0 2 of 25 8 .491 Toxicity deaths 3 of 47 6 2 of 22 9 1 of 25 4 .593 Relapse 16 of 47 34 10 of 22 45 6 of 25 24 .215 AlloHSCT 11 of 47 23 7 of 22 32 4 of 25 16 .303 Disclosures No relevant conflicts of interest to declare.

Description: Background: Burkitt lymphoma (BL) is a highly aggressive non-Hodgkin lymphoma associated with translocations involving the c-MYC oncogene on chromosome 8. The 1996 Magrath regimen, CODOX-M/IVAC, showed a promising 2-year (y) event free survival (EFS) of 92% in 41 BL patients (pts), with additional trials of a dose-modified regimen demonstrating 2y overall survival (OS) 70-82% and 2y progression-free survival (PFS) 64% (Mead et al). A recent trial demonstrated that with addition of R, 3y OS and EFS were 83% and 75% (Ribrag et al). We sought to determine survival outcomes of adult BL pts in BC treated with CODOX-M/IVAC +/- R to evaluate the effectiveness of this regimen on a population basis. Methods: All pts 〉=18 years of age diagnosed with BL from Jan. 1, 2001-Dec. 31, 2015 and initiated on CODOX-M/IVAC +/- R were identified through the Leukemia/BMT Program of BC database and cross-compared with the BC Cancer Agency Lymphoid Cancer clinical and pathology databases. The risk-adapted Magrath protocol has been standard of care in BC since 2001, with R added as of 2004. Bone marrow transplant (BMT) in first remission was considered in eligible pts until 2010. Primary outcomes were OS and PFS. Factors significantly affecting survival outcomes on univariate analysis (P= 5 cm), 46 (64%) 〉1 extranodal site, 28 (39%) BM involvement, 7 (10%) central nervous system (CNS) involvement, 9 (13%) HIV positive. 2 pts were considered low risk (limited stage, no bulk, normal LDH, no BM/CNS involvement). Median time from diagnosis to treatment was 8 days (range 0-61). 40 (56%) received the Magrath regimen per protocol while 32 (44%) had treatment modifications, including dose reductions and omission of chemotherapeutic agents due to age, comorbidities and/or toxicity. 68 (94%) pts received R, 57 (79%) methotrexate, 6 (8%) radiation therapy, and 16 (22%) had a BMT in first remission (13 autologous, 3 allogeneic). Median follow-up of living pts was 3.6 yrs (range 0.4-12.3). At last follow-up, 56 (78%) pts were alive, 16 died (14 progressive BL, 1 treatment-related toxicity, 1 lung adenocarcinoma). 2y and 5y OS were 80% and 75%, respectively; 2y and 5y PFS were 79% and 77%, respectively (Figure 1). 16 (22%) pts relapsed, of which 15 died from progressive disease and 1 remains in remission post alloBMT. 15 pts relapsed within the first year of diagnosis, while 1 relapsed at 2.16 y from diagnosis. A subset analysis of pts who received the Magrath regimen per protocol (N=40) was performed and demonstrated 2y and 5y OS each 92% with 2y and 5y PFS each 90%. Factors significantly affecting OS and PFS for the whole cohort in univariate analysis were: age 〉60y (OS P=.003; PFS P=.021), BM involvement (P=.064; P=.020), IPI 4-5 (P=.008; P=.019), elevated LDH (P=.026; P=.006), and no R in the regimen (P

Description: Introduction Acute myeloid leukemia (AML) in older adults is a challenging clinical problem with a poor prognosis. Hypomethylating agents, such as azacitidine, improve survival in this population. (Oran B, Haematologica 2012) These treatments can be challenging to deliver, particularly in patients far from tertiary care centres. We examined whether residence outside of a major metropolitan area impacted referral patterns, treatments, and outcomes in a population-based cohort of AML patients over age 60 in British Columbia (BC), Canada. Methods Patients with ICD-10 diagnoses of AML were identified from the population based BC Cancer registry and BC Cancer pharmacy database. Diagnoses between 2010 and 2016 were included. Exclusion criteria included diagnosis age less than 60 years, any treatment outside BC, or APL. The diagnosis of AML was verified by chart review. Azacitidine was available at our institution in 2010, and is used primarily for patients with bone marrow blast counts below 30%. Patients were defined as having a hematologist/oncologist assessment if a provider with these credentials was listed in notes or pathology reports. Patients were defined as having received a treatment if it was dispensed at least once, with a date after AML diagnosis. Patients were defined as urban if they had a mailing address in a center of 〉/= 100,000 people, per the Statistics Canada definition, and rural if they had a mailing address elsewhere. Urban residences included greater Vancouver, Victoria and Kelowna, which comprise 71.5% of the population. (Statistics Canada, 2016 census) Between group differences were assessed by 2-tailed t-test or chi-square tests. Overall survival (OS) was assessed by Kaplan-Meier, with a log-rank test, and Cox regression. A p 〈 0.05 was significant. Results A total of 879 patients over age 60 with AML, excluding APL, were identified. Of these, 525 (60%) resided in urban areas vs 354 (40%) residing in rural areas. These groups were similar for median age at diagnosis (urban 75.9 years, rural 74.3 years, p = 0.067), adverse cytogenetic profile (urban 56%, rural 44%, p = 0.356), NPM1 positivity (urban 69%, rural 31%, p = 0.101) and FLT3 positivity (urban 76%, rural 24%, p = 0.052). Rural residents were less likely to have a documented hematologist/oncologist assessment (urban 84%, rural 65%, p 〈 0.001). Few patients overall received induction chemotherapy (151, 17%), with no difference between rural and urban residency (p = 0.524). Similarly, few patients underwent hematopoietic stem cell transplantation (38, 4%), with no difference with place of residence (p = 1.000). Median OS for patients treated with induction chemotherapy was 11.0 months (95% CI 9.0 - 13.1 mo). Median OS for patients treated with subcutaneous (SC) azacitidine was 7.1 months (95% CI 4.8 - 9.5 mo) vs 4.7 months (95% CI 3.3 - 6.1 mo) with SC cytarabine. With best supportive care, the median OS was 1.7 months (95% CI 1.5 - 1.9 mo). Median follow-up was 43.7 months (95% CI 39.2 - 48.2 mo), with 706 (97%) of patients deceased at last follow-up. Amongst the 728 patients who did not receive induction chemotherapy, 82 (11%) received SC cytarabine and 127 (17%) received SC azacitidine. Place of residence did not impact whether patients received SC cytarabine (urban 10%, rural 13%, p = 0.285). Rural residents were, however, less likely to receive SC azacitidine (urban 21%, rural 12%, p = 0.002). In patients not undergoing induction, rural residents had a worse OS by Kaplan-Meier analysis (p = 0.021), with a hazard ratio of 1.2 (95% CI 1.026 - 1.387, p = 0.022) on univariate Cox regression. Conclusions Older adults with a diagnosis of AML who reside in rural areas of BC are less likely to have a documented hematologist/oncologist assessment, and are less likely to receive SC azacitidine. This group also has a worsened OS, though the effect size is modest. There was no difference in rates of treatment with potentially curative regimens, although this approach applied to a minority of patients. We hypothesize that this difference may be partially due to the travel burdens placed on rural patients who receive SC azacitidine, which must be administered in a healthcare facility, unlike SC cytarabine. Less access to supportive care in rural areas is also likely a contributing factor. Policymakers should direct additional resources for rural oncologic healthcare delivery, and the importance of low burden drug formulations is AML should be emphasized. Disclosures No relevant conflicts of interest to declare.

Description: Introduction: Cytogenetic features at diagnosis have significant independent prognostic impact in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Failed or unsuccessful cytogenetics (UC) is estimated to occur in 10% of AML cases and 25-30% of ALL cases (Grimwade, 2010; Pullarkat, 2008). Previous studies suggest worse outcomes in AML patients (pts) with UC, similar to pts with unfavorable karyotype with lower response rates to induction chemotherapy and poor 5-year (yr) survival rates (Medeiros, 2014; Lazarevic, 2015). Hydroxyurea (HU) and steroids are often given urgently for cytoreduction prior to obtaining cytogenetics. The effects of such pretreatment on rates of UC have not been studied previously. In this study, we compared clinical outcomes of acute leukemia pts with UC versus successful cytogenetics (SC) and determined whether the use of HU or steroids affects cytogenetics success rates. Methods: All pts

Description: Background: Peripheral T-cell lymphomas (PTCL) are a rare and heterogeneous group of non-Hodgkin lymphomas (NHLs) that accounts for approximately 10% of all aggressive NHLs in Western countries. The optimal management remains unclear, however, given the poor outcome, allogeneic transplant (allo-SCT) has been integrated into the front-line treatment for some rare extranodal subtypes as well in relapsed/refractory setting. We report our provincial experience of the outcome of patients with PTCL who have undergone allo-SCT at the British Columbia Cancer Agency (BCCA). Methods: The Leukemia/BMT Program of British Columbia database and the BCCA Lymphoid Cancer Database were searched to identify all patients diagnosed with PTCL who have undergone allo-SCT between November 1990 and January 2016. Overall survival and relapse free survival were estimated using the Kaplan-Meier method. Results: We identified 36 cases of PTCL patients who have undergone allogeneic transplant from a median time of 11 months from primary diagnosis (range 4-64) with the following clinical features: median age at transplant was 45 years (range 16-58 years); 24 (67%) were male; 32 (89%) patients had advanced stage disease; 22 (61%) had B-symptoms at diagnosis. Bone marrow involvement detected in 13/34 (38%) patients. Histological diagnosis based on the WHO 2008 classification were: Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) n=15 (42%); anaplastic large cell lymphoma (ALCL) n=7 (19%) out of which three were ALK positive, angioimmunoblastic T-cell lymphoma (AITL) n=6 (17%), hepatosplenic T-cell lymphoma n=5 (14%), enteropathy associated T-cell lymphoma type I n=1, advanced primary cutaneous gamma-delta T-cell lymphoma n=1 and Sezary syndrome n=1. Ten patients (28%) underwent allo-SCT as part of planned primary therapy after achieving their first remission [6 were in complete remission 1 (CR1) and 4 were in partial remission 1 (PR1)], whereas 26 patients (72%) underwent allo-SCT for relapsed/refractory disease. CHOP was administered in 19 patients (53%) as the primary therapy. 17 (47%) patients received alternative chemotherapy regimen due to patient and/or physician preference. The clinical status at the time of transplantation was CR in 12 patients (33%), relapsed sensitive disease n=10 (28%), relapsed untreated n=5 (14%), partial remission (PR) in 5 (14%), primary progressive disease n=3 (8%) and relapsed resistant disease n=1 (3%). Thirty two patients (89%) underwent myeloablative conditioning, 4 (11%) underwent reduced intensity conditioning (RIC). The conditioning regimens included: cyclophosphamide/TBI n=24 (67%), busulfan/cyclophosphamide n=5 (14%), fludarabine containing reduced intensity n=4 (11%), and other regimens n= 3 (8%). With a median follow-up of alive patients from the time of allo-SCT of 69 months (range 1-186 months). At last follow-up, 17 (47%) patients have died, 6 from disease relapse, 5 from graft vs host disease (GVHD), 2 from regimen related toxicity and 4 from other causes. Nineteen patients (53%) still alive at last follow up post-transplant of which 14 (39%) still in remission. The 5-year event free survival (EFS) and overall survival (OS) from the time of allo-SCT of all patients were 43% and 63%, respectively. For PTCL-NOS the 5-year EFS and OS were 52% and 69%, respectively. Table 1 summarizes the patients' characteristics. Figures 1 and 2 shows the Kaplan-Meier curves for OS and EFS respectively. Conclusion: Allo-SCT can be effective strategy in select patients with relapsed/refractory PTCL and those with high risk histologies in the upfront setting PTCL with an acceptable toxicity. Disclosures Toze: Roche Canada: Research Funding. Sehn:roche/genentech: Consultancy, Honoraria; amgen: Consultancy, Honoraria; seattle genetics: Consultancy, Honoraria; abbvie: Consultancy, Honoraria; TG therapeutics: Consultancy, Honoraria; celgene: Consultancy, Honoraria; lundbeck: Consultancy, Honoraria; janssen: Consultancy, Honoraria. Scott:NanoString Technologies: Patents & Royalties: named inventor on a patent for molecular subtyping of DLBCL that has been licensed to NanoString Technologies. Villa:Lundbeck: Honoraria; Roche: Honoraria, Research Funding; Celgene: Honoraria. Connors:NanoString Technologies: Research Funding; F Hoffmann-La Roche: Research Funding; Bristol Myers Squib: Research Funding; Seattle Genetics: Research Funding; Millennium Takeda: Research Funding. Song:Janssen: Honoraria; Otsuka: Honoraria; Celgene: Honoraria, Research Funding.

Description: Background Salvage chemotherapy using high-dose etoposide and cyclophosphamide (VP-Cy) was developed for acute leukemia and myeloid malignancies resistant to cytarabine-based induction regimens. The Leukemia/Bone Marrow Transplant (L/BMT) program of British Columbia has a 25-year experience using VP-Cy for patients with relapsed and refractory (R/R) acute myeloid leukemia (AML). We report on a retrospective analysis to evaluate the efficacy and early toxicity of this regimen. Methods The L/BMT database was searched to identify R/R AML patients treated with VP-Cy. Patients were treated with etoposide 2.4 g/m2 given as continuous infusion over 34 hours on days 1-2 followed by cyclophosphamide 2 g/m2/day on days 3-5. The primary aims of this analysis were to determine response rate, long-term survival outcomes, and early toxicity. Secondary aims were to determine the impact of initial induction chemotherapy, using either standard-dose cytarabine and daunorubicin (7+3) or high-dose cytarabine and daunorubicin (HiDAC-D), on response rate to salvage as well as to assess the impact of cytogenetics and FLT3-ITD mutations on outcome. Survival curves were calculated using the Kaplan-Meier method, and comparisons between curves were made using the log-rank test. Chi-squared test was used to compare differences in categorical variables. Results 169 patients diagnosed with R/R AML treated with VP-Cy from 1991-2015 were identified. Baseline characteristics are shown in Table 1. CR rate was 45% and 5-year OS was 20% (95% CI 14-26%) for the entire cohort. Rate of CR (p=0.98) and median OS (p=0.8) were not different between cohorts receiving standard-dose cytarabine vs. high-dose cytarabine during initial induction. 74% (56/76) of responding patients received allogeneic hematopoietic stem cell transplant. 42% (32/76) of patients relapsed after initially responding to VP-Cy and the median CR duration was 221 days (range: 36 to 2561 days). In responding patients (n=76), 5-year relapse-free survival (RFS) and OS were 33% (95% CI 24-46%) and 35% (95% CI 25-47%) respectively. Initial disease status did not significantly influence response rate [52% (refractory day 14) vs. 42% (refractory day 28) vs. 47% (relapsed), p=0.46] although median OS was longer in patients with refractory disease [422 days (refractory day 14) vs. 281 days (refractory day 28) vs. 122 days (relapsed), p=0.03)]. Patients with FLT3-ITD mutation (30/78) had lower CR rate (23% vs. 53%; p=0.01) and worse OS (median OS 135 days vs. 357 days; p

Description: Introduction: MM remains incurable but therapeutic advances has resulted in improved overall survival (OS) particularly for younger pts who are eligible for ASCT. Regardless OS improvements have been heterogeneous and it is well known that relapse within one year of ASCT is an independent negative prognostic factor. A particularly worse subgroup is pts who relapse and die of MM within a year of ASCT. There is limited data describing this subgroup of pts, the risk factors associated with their early relapse post ASCT and characteristics at relapse. Objective: Describe patient and disease related characteristics among MM pts who underwent ASCT and died of relapsed MM within the first year post ASCT in the era of novel agents. Methods: Pts were identified from the Leukemia/BMT Program of B.C. database, underwent ASCT between January 1st 2007 and July 31st 2016 and died of MM related causes within 365 days post ASCT. During this time period bortezomib (BORT) and lenalidomide (LEN) were available as second line therapy and BORT was available as induction pre-transplant for defined circumstances including high risk cytogenetics. Out of 752 ASCTs, 702 were performed as a part of initial therapy. The remaining ASCTs were performed as salvage or were the second of planned tandem ASCTs. Among the remaining 702 pts 37(5.3%) died within the first 365 days post ASCT. Of the 37 pts, 32 died from MM and related causes, 2 died of TRM from ASCT and 3 died from other causes not related to MM or ASCT. The 32 pts (4.6% of the total) who died of MM and related causes were matched with 64 controls (2:1 ratio) who were selected randomly from the remaining patient cohort and matched for age, gender, and year of transplantation. Results: There was no difference in Age at diagnosis (Median: case 61 VS control 60, P= .97) or gender (Male case 40.6% VS control 35.9%, P= .66). There was no significant difference in the prevalence of anemia, renal dysfunction, or hypercalcemia between both groups at diagnosis (table). Pts who died within the first year of ASCT had a more advanced stage at diagnosis compared to the control group (ISS Stage III: 53.1% vs 18.8%, P= .003). BORT based induction therapy was used in 84.4% of the cases compared to 53.1% in the control group, P= .001. The majority of pts in both groups had partial response or better to frontline therapy (Cases: 81.2% VS Controls 79.7%, P= .5). Only 9.4% of cases and 4.7% of controls had evidence of disease progression at the time of ASCT. High risk cytogenetics (t(4;14), t(14;16), or del 17p) were significantly more prevalent among pts who died within the first year post ASCT compared to the control (58.82% vs 31.67%, P= .009). There was no difference in the monoclonal protein subtype between the cases and controls, P= .55. The median time from ACST to disease relapse was 118 days (40-319) for the case group compared to 511 (107-1958) in the control group. Within the case group, 19 (59.3%) received LEN based therapy as second line therapy and 9 (28.1%) received BORT based therapy. Three patients (9.37%) were not candidates for any further therapy due to acute illness (2 sepsis, 1 subdural hemorrhage) related to fulminant MM relapse and one patient (3.1%) decided not to proceed with therapy due to functional decline. Overall, 17 pts (53.1%) received both BORT and LEN during the disease course, 12 (37.5%) received BORT only, 2 (6.25%) received LEN only and one received neither (3.1%). At the time of disease relapse, 9 (28.1%) had Hb level