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PURPOSEThe study of rare diseases, such as multiple myeloma (MM), often experiences unique research hurdles that can delay or prevent lifesaving discoveries. HealthTree Cure Hub is a first-in-class software program designed to overcome these potential research hurdles.METHODSWe assessed whether HealthTree Cure Hub improved four commonly experienced research hurdles such as (1) small numbers of patient accrual to clinical trials and research studies, (2) shallow and isolated data sets, (3) high costs to answer research questions, and (4) lack of long-term follow-up patient data.RESULTSAs of June 2021, HealthTree Cure Hub, with its unique portal features, has attracted 9,225 patients with MM and diverse demographic backgrounds. While completing an online health profile, patients shared comprehensive data, as well as provided consent to contribute data from electronic medical records. Portal use answered research questions using patient-driven real-world data. This also cultivated relationships with patients and established communication channels that enabled continual patient contact to allow for long-term follow-up.CONCLUSIONThese results suggest that a patient-driven data capture tool such as HealthTree Cure Hub will help alleviate common research hurdles, which, in turn, will accelerate MM research, develop new hypotheses, and ultimately improve survival.

BACKGROUND: Learning about a new multiple myeloma (MM) or smoldering MM (SMM) diagnosis is an important but difficult first step of a cancer journey. However, the education process can be overwhelming, especially within ethnic minorities and the medically underserved. Moreover, recent studies suggest that too much information may lead to confusion, frustration, and could negatively impact the decision-making process. Therefore, the primary purpose of this survey was to capture the common questions and concerns of MM and SMM patients when they were newly diagnosed and since diagnosis within the Mexican, Hispanic and Latino ethnicities and compare their responses to non-Hispanic or Latino ethnicities. METHODS: We utilized HealthTree® Cure Hub and invited patients with MM or SMM to participate in an online survey consisting of selecting from a list of 20 topics of what their questions were at diagnosis and since diagnosis. RESULTS: Of the 36 myeloma patients identified as Mexican, Hispanic or Latino 86% had MM and 14% had SMM, 95% were diagnosed before 2019, 91% saw a specialist, 66±8 years, 53% female, 56% retired, 31% reported currently working, and 97% had health insurance. The non-Hispanic or Latino group consisted of 248 patients, 78% with MM and 26% with SMM, 81% were diagnosed before 2021, 78% saw a specialist, 65±8 years, 58% female, 52% retired, 29% reported currently working and 98% had health insurance. The top 5 questions at diagnosis were identical between groups: What are the myeloma treatment options?, What is my life expectancy?, What is myeloma?, What can I expect during treatment?, and Can myeloma be treated? However, since diagnosis the top 5 concerns changed and a key divergence between groups occurred. Importantly, the top new concern for both groups was, Is a clinical trial right for me?, and both groups added the question: What side effects would I experience? The two groups did differ, the non-Hispanic group added one additional question: What can I do to prevent further spread of the disease? While, in contrast, the Mexican, Hispanic and Latino group added two questions, within a similar domain, which was not previously observed: Should I consider a second opinion?, and Does my doctor have sufficient experience? DISCUSSION & CONCLUSION: These results identified major concerns of MM and SMM patients at and since diagnosis and this study documents critical ethnicity divergence that occurs as patients become more experienced with managing their myeloma. Interestingly, both ethnicities shared the same top 5 concerns at diagnosis and had some similarities of new concerns since diagnosis. However, the Mexicans, Hispanics, and Latinos reported new concerns that involved questioning their doctors’ competence and the desire of a second medical opinion for medical decisions. In conclusion, although ethnic groups largely have similar questions and concerns at and since diagnosis, Mexican, Hispanics and Latinos express interest in assuring they are being treated by experienced doctors and highly value second medical opinions. Citation Format: Jay R. Hydren, Nathan W. Sweeney, David F. Barton, Jorge Arturo Hurtado Martinez, Jennifer M. Ahlstrom. What are the top myeloma patient concerns at and since diagnosis of Mexicans, Hispanics and Latinos? [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A004.

Background: Although Black Americans have 2-3 times multiple myeloma (MM) incidence and mortality as compared to Whites, increasingly research is demonstrating that many may have genetic characteristics that have better survival outcomes. Yet delayed diagnoses and inappropriate first lines of therapy often wipe out whatever “advantages” they may have had, keeping mortality statistics higher than would be expected (PMID: 25469920). For underserved populations, a number of commonly accepted disparities exist in myeloma, and more broadly, cancer care. Patients who receive treatment by a high-volume provider (myeloma specialist) is a factor that can help patients with MM to have a longer life expectancy (PMID: 31487686). Therefore, we analyzed whether there is a disparity between race and receiving care from a myeloma specialist which may contribute to the differences in survival that is being seen. Methods: Validated real-world (RW) MM patient data was collected through HealthTree Cure Hub for Multiple Myeloma (healthtree.org). We examined the patient’s race which was either Caucasian American or Black American and whether or not they were being treated by a myeloma specialist. The association between race and specialist was examined by a chi-squared (X2) test. Results: In this retrospective analysis of 2,871 MM patients, we compared Caucasian Americans (n= 2716) and Black Americans (n=155). Our analysis revealed a significant association between the two races and whether or not they had a myeloma specialist, X2(1, N = 2,871) = 5.85, p = 0.015. Black Americans were less likely to be treated by a myeloma specialist. Conclusion: The findings of this RW analysis identify a glaring disparity in Black American MM patients and receiving care from a myeloma specialist. Addressing the underlying cause of the findings could extinguish other MM-related issues, such as delays in getting a correct diagnosis, lack of access to myeloma specialists, and many other non-medical issues leading to less-than-optimal outcomes from the majority of these Black American patients. Citation Format: Christian S. Cheung, Nathan W. Sweeney, Zena M. Tiu, Cynthia Chmielewski, Jennifer M. Ahlstrom. Comparison of multiple myeloma provider for Black Americans and Caucasian Americans [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6287.

Background: Multiple Myeloma (MM) is a rare cancer affecting plasma cells. Patients with MM have several lines of treatment options and overall survival has increased with current treatments, nonetheless, MM remains currently incurable. It has been recently noted that ABO blood types may influence the survival of MM patients (PMID: 33362882). The purpose of this study is to find if there is a relationship between the survival of MM patients and their ABO blood type. Methods: Patients were drawn from the self-reported HealthTree Cure Hub database which included 1,173 individuals. 458 patients reported having A blood type, 56 patients reported having AB blood type, 155 patients reported having B blood type, and 504 patients reported having O blood type. Patients who did not report a blood type were excluded from this analysis. An analysis of variance was conducted to analyze the relationship between the survival time (total time to next treatment) and a patient's ABO blood type. A t-test was conducted to compare the survival time of O blood group with other blood types. Additionally, an analysis of variance was conducted to determine the relationship between ABO blood groups and a patient's likelihood of being considered high risk. Results: We found that there was a relationship between total time to next treatment and ABO blood type. On average the total time to next treatment of MM patients with O blood type was longer compared to other blood types with an average of 2027 days. Patients with A blood type had an average of 1762 days, AB blood type had an average of 1882 days, and B blood type had an average of 1747 days. While the difference in average survival time was not statistically significant (p-value = 0.138), it is still worth noting that there is a difference in average total survival time for patients with O blood type. We further compared the average total time to next treatment between O blood group and all other blood types. We saw that there was a statistical significance (p-value = 0.040) and concluded that on average the survival time of patients with O blood type is higher than other blood groups by 250 days. We also investigated whether or not patients in certain ABO blood groups are more inclined to have high-risk mutations. We categorized patients as high risk and standard risk-based on guidelines defined by Mayo Clinic’s mSMART. We found that there was no statistical significance (p-value = 0.797) and concluded that patients are equally likely to be considered high risk for all ABO blood groups. Conclusion: Our results indicated that MM patients with blood type O have a longer survival time on average than patients with blood type A, AB, and B. We saw that a patient’s likelihood of having a high-risk mutation is the same across all ABO blood groups. Our results may help lead to further research investigating why despite having a similar proportion of patients who are considered high risk, patients with O blood type differ in average survival time. Citation Format: Zena M. Tiu, Nathan W. Sweeney, Christian S. Cheung, Cynthia Chmielewski, Jennifer M. Ahlstrom. Relationship of ABO blood groups and length of survival of multiple myeloma patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6286.

8046 Background: As treatments advance in multiple myeloma (MM) and increasingly deeper and longer responses are achieved, the definition of what a cure is becomes increasingly relevant. While many physicians quote that patients may achieve a “functional cure”, understanding the patient perspective on the concept of cure has yet to be explored. Methods: HealthTree Cure Hub by the HealthTree Foundation represents an online portal for patients with plasma cell dyscrasias to help navigate their disease. It is the largest single database of patients with multiple myeloma with over 10,200 patients as of January 2022. Using this platform, we surveyed patients online from November 11th 2021 to Feb 7th 2022. Varying scenarios incorporating toxicity, disease status, and being on/off treatment were presented, and participants were asked to rate them from 1-5, with 5 being an ideal cure. Patient awareness of the term functional or operational cure was also. Results: A total of 1525 participants completed the survey. Table lists characteristics of the patients who completed this survey. The majority of the patients were female (55.5%), college educated (88.5%) and non-Hispanic White (70.7%). Most patients rated being off treatment permanently and having no evidence of disease as a cure (1116/1469, 75.5%), with a median score of 5 amongst respondents, indicating an ideal version of cure. Continuing to take the same pill or injection with significant toxicity and no evidence of disease had a median score of 1, a score lower than either “continuing to take same pill or injection without significant toxicity even in the evidence of disease” (median score 2) or “stopping treatment permanently even with some detectable disease” (median score 2). The majority of patients (76.3%) reported being unfamiliar with the term functional or operational cure. Conclusions: In the first study of patients with plasma cell dyscrasias in which patients were asked about their perceptions of what a cure is, our results highlight that drug toxicity and being on treatment profoundly impacts patient's perception of cure. Furthermore, most patients are not familiar with the term functional or operational cure. Future efforts should recruit more diverse patient populations and incorporate patient preferences in approaches to defining cure in myeloma, as well as explaining cure in easily comprehensible terms to patients. [Table: see text]

8058 Background: Previous studies have observed smoldering multiple myeloma (SMM) patients with a biomarker criteria of > 20% bone marrow plasma cells, > 2 g/dL M protein spike, and > 20 free light chain ratio, also known as 20/2/20, are at a higher risk of progressing to multiple myeloma (MM) than others. These findings have ignited interest in pursuing early intervention for these high-risk patients. However, we asked if early intervention would be beneficial for all SMM patients regardless of the progression risk level. Methods: We utilized real-world data from HealthTree Cure Hub for Multiple Myeloma to first, determine whether 20/2/20 resulted in a higher risk of progression and second, analyze whether early intervention delayed progression from SMM to MM. A 2-sample t-test was used to compare 20/2/20 to non-20/2/20 patients, as well as in the comparison between SMM patients who received early intervention with treatment to without early intervention. Results: We found that patients who met at least two of the criteria of 20/2/20 had a tendency to progress to MM 35% faster than patients who did not meet the criteria (n = 36, p-value < 0.10). While not significant, it’s still worth noting that there is a difference in the mean time to progression for these patients. Next, we found SMM patients who do not receive early intervention with treatment develop MM two times faster than those who do receive early intervention with treatment, regardless of progression risk level (n = 129, p-value < 0.001). Conclusions: Our results revealed that at least two of the biomarker criteria could aid in the identification of patients with a higher risk of progression. However, a casual approach of “sit and wait” for patients to develop 20/2/20 is not warranted since our findings revealed that all SMM patients benefited from treatment intervention regardless of the progression risk level.

e20003 Background: People that live in rural areas experience significant health disparities from higher incidences of disease and disability, increased mortality rates, and lower life expectancies. Rural risk factors for health disparities include geographic isolation, lower socioeconomic status, limited access to healthcare specialists and sub-specialists, and limited job opportunities. Interestingly, we often see other, non-white, races experience delays in care, are under-treated, and lack of access to MM specialists. We, therefore, investigated whether there was a relationship between race and where one lives geographically. Methods: Validated real-world (RW) MM patient data was collected through HealthTree Cure Hub for Multiple Myeloma (healthtree.org). We examined the patient’s race which was either Caucasian American (White) or any other race (Black American, Asian, American Indian, East Indian, Middle Eastern, or Native Hawaiian) which was categorized as “non-White” and where they lived geographically (Rural, Urbanized Cluster, or Urban Areas). The association between race and geographic classification was compared by using a chi-squared test. Results: In this retrospective analysis of 2,687 MM patients, we compared the geographical classification of Whites (n = 2403) and non-Whites (n = 284). Our analysis revealed a significant association between the two groups and where they lived with a chi-square value of 20.455 (2, n = 2,687, p < 0.001). We found that Whites are 1.9 times more likely to live in urbanized cluster areas and 2.7 times more likely to live in a rural area compared to non-Whites. Conclusions: The results of this RW analysis identified a disparity among races and where one lives geographically. While there is strong evidence of health disparities our findings revealed that where one lives geographically is not a probable reason why non-Whites experience delays in care, are under-treated, or lack access to MM specialists.

Background: Patients with multiple myeloma (MM) are uniquely susceptible to viral and bacterial illnesses, including COVID-19, due to their immunocompromised state, age, treatments, and comorbidities. With the advent of COVID-19, changes to treatment were recommended whenever possible, in order to reduce visits to the clinic. The total effect of these changes on cancer patients with multiple myeloma remains unclear. The aim of this project was to assess treatment management by changes to treatment of patients with MM during the COVID-19 pandemic. Methods: We utilized HealthTree ® Cure Hub for Multiple Myeloma (healthree.org) and invited patients with active MM cancer or precursor conditions to participate in an online survey. We analyzed patient responses to questions regarding their myeloma treatments during the COVID-19 pandemic. Results: 978 MM patients participated in the survey between February to June 2021. Since March 2020, 151 patients (15%) either delayed, postponed, or stopped a myeloma treatment because of COVID-19. The four most common treatments were daratumumab (20%), lenalidomide (15%), stem cell transplant (13%) and zoledronic acid (11%). There were 110 patients that canceled a planned myeloma treatment. Of these patients, 55 (50%) canceled a planned chemotherapy, 15 (14%) canceled a stem cell transplant, 1 (1%) canceled radiation and 39 (35%) indicated other. Eight patients replaced an intravenous or subcutaneous treatment with an oral treatment because of COVID-19. There were 9 patients that started a new myeloma treatment because of COVID-19, the most common being daratumumab (44%), ixazomib (22%), lenalidomide (22%) and carfilzomib (11%). Finally, 15 patients had their lenalidomide (50%), steroid (42%) and carfilzomib (8%) dose changed. Conclusions: Our results show that decision-making regarding treatment changes were made on an individual basis and that patients who required a change in treatment were the minority. Aggregating real-world data can provide evidence that despite the changes, patients with MM still received and efficacious treatment and avoided putting these patients at risk or mortality. Disclosures Ahlstrom: Bristol Myers Squibb: Other: Patient Advisory; Janssen: Other: Patient Advisory; Pfizer: Other: Patient Advisory; Takeda: Other: Patient Advisory.

Background: A question that was commonly investigated during the COVID-19 pandemic was which clinical characteristics would make one more susceptible to contracting COVID-19? This was especially a concern for those who were considered "high risk" as they would be more prone to suffering from more severe COVID-19 symptoms and at times even death. In this abstract, we investigated which clinical characteristics of multiple myeloma (MM) cancer patients could make them more prone to contracting COVID-19. We also investigated which of these conditions make patients more at risk for experiencing more severe COVID-19 symptoms (PMID: 32950467, PMID: 32353254). Knowing what medical conditions that would make a patient more at risk for contracting or experiencing a more severe case of COVID-19 has been a concern for many, especially for those who suffer from more severe health conditions such as cancer. Methods: MM patient data and demographics were collected through HealthTree ® Cure Hub for Multiple Myeloma. We analyzed medical conditions including hypertension, heart condition, neuropathy condition, and BMI. We also looked into lung condition, kidney condition, diabetes, stroke, smoking history, drug use history, HIV, and Mediterranean descent but did not include in the figure due to small population sizes. We determined whether a patient had to be hospitalized, admitted to the ICU, needed oxygen therapy, or needed a D-dimer test as a severe COVID-19 case. Multivariable logistic regressions were performed to quantify the risk for contracting COVID-19 for patients with specific medical conditions and which medical conditions made COVID-19 positive patients more at risk for experiencing a more severe case of COVID-19. Results: Out of the 962 patients that were involved in this study, we found that patients who were overweight were 2% more likely to contract COVID-19 than those who were not overweight. Other medical conditions did not increase the risk of contracting COVID-19. Furthermore, there were 35 patients that were involved in investigating how certain medical conditions may affect the severity of COVID-19 symptoms. We found that overweight patients were 12% more likely to suffer from more severe COVID-19 than those not overweight. Patients who suffered from neuropathy conditions were 3% more likely to experience a more severe COVID-19 case than those who do not have that condition. It is important to note that these results were not statistically significant, although are still informative. Conclusion: Our results show that MM patients who are overweight have a greater tendency to not only contract COVID-19 but experience a more severe case of COVID-19. Somewhat surprisingly, we found that patients who experience neuropathy, common among MM patients, had a higher tendency to experience a more severe case of COVID-19. We speculate whether MM patients, a high-risk group due to their immunocompromised state, took extra care to follow safety recommendations and caution to avoid contracting COVID-19. A logical next step would be to compare medical condition interactions to examine whether patients with more than one condition experience additive or synergistic risk, as well as comparing out results to other high-risk groups. These findings, although not statistically significant, may help MM patients identify which of their own medical conditions may put them more at risk for contracting COVID-19 and thus take precautionary measures. Figure 1 Figure 1. Disclosures Ahlstrom: Takeda: Other: Patient Advisory; Pfizer: Other: Patient Advisory; Janssen: Other: Patient Advisory; Bristol Myers Squibb: Other: Patient Advisory.

Background: Since the start of the COVID-19 pandemic, "high-risk" patients, such as cancer patients, have had to reconsider their current medical treatments and other treatment alternatives to best minimize their risk for contracting COVID-19. Lenalidomide has immunomodulatory properties that stimulate the production of T-cells which help combat against infections which may include diseases such as COVID-19. In this abstract, we investigate whether lenalidomide protects multiple myeloma (MM) patients from contracting COVID-19 and whether lenalidomide decreases the severity of COVID-19 events (including hospital or intensive care unit [ICU] admissions, and need of assisted ventilation) for patients that contract the virus (PMID: 32950467, PMID: 32353254). Methods: MM patient data was collected through HealthTree ® Cure Hub for Multiple Myeloma (healthtree.org) and the relative risk was calculated to compare the risk of contracting COVID-19 between patients taking lenalidomide and those who were not at the time of contracting COVID-19. The odds ratio was calculated to measure lenalidomide's effect on the severity of COVID-19 if contracted. These events include whether a patient was hospitalized, had to go to the ICU, or required oxygen therapy. Results: There were 1,123 patients involved in comparing lenalidomide with the risk of contracting COVID-19, including patients that never tested positive for COVID-19. Surprisingly, our results showed that patients who are taking lenalidomide have a 10% higher risk for contracting COVID-19 than those who are not; however, these findings were insignificant. Furthermore, 40 patients were involved in investigating lenalidomide's effect on decreasing severe COVID-19 symptoms for MM patients. Our results showed that the odds of patients experiencing severe COVID-19 were 1.95 times more for those on lenalidomide than those who were not. Conclusions: Despite the insignificance of lenalidomide during COVID-19, our results indicated that taking lenalidomide may not be beneficial in lowering the risk for MM patients in contracting COVID-19. Furthermore, lenalidomide may also not decrease the severity of COVID-19 symptoms for MM patients that did contract COVID-19. Our results may help MM patients and their providers decide whether to continue their use of lenalidomide or to seek alternative treatment options. Disclosures Ahlstrom: Pfizer: Other: Patient Advisory; Janssen: Other: Patient Advisory; Takeda: Other: Patient Advisory; Bristol Myers Squibb: Other: Patient Advisory.

Background:The rapid outbreak of coronavirus disease 2019 (COVID-19) led to delays of non-urgent or routine medical care. Regulatory waivers and policy changes from the Centers of Medicare and Medicaid Services (CMS) for the use of telehealth came as a solution to help fight the outbreak. The aim of this project was to survey the change in the frequency of use of telehealth services among multiple myeloma (MM) patients during the COVID-19 pandemic. Methods:We utilized HealthTree Cure Hub For Multiple Myeloma (healthree.org) and invited patients with active MM cancer or precursor conditions to participate in an online survey. We analyzed patient responses to doctor visits, the use of telehealth before and after the COVID-19 pandemic, and whether they had sufficient access to their doctor. Results:1,301 MM pts participated in the survey between April 15, 2020, and June 8, 2020. During the pandemic, 36% of patients indicated visiting with their physician less often than before, 2% visited more often, and 62% had no change in the frequency of their visits. The percent of patients responding “Sometimes” or “Yes” to the use of telehealth are reported here. Before the pandemic, 10% of patients used telehealth, while 62% of patients indicated using telehealth during the pandemic, a 523% increase. When asked if they had sufficient access to their MM healthcare provider 90% of patients indicated that they did, while 10% indicated they did not. Conclusions:There were significantly fewer in-person visits during the COVID-19 pandemic likely due to the CDC-recommended physical distancing practices. During this time, telehealth use among MM patients dramatically increased compared to telehealth use before the pandemic. It is reasonable to assume that patients indicated having sufficient access to their healthcare provider as a result of patients receiving care through telehealth visits. The authors encourage readers to think more broadly about the benefits of telehealth. Maintaining sufficient access to one healthcare provider addressed in this abstract is only a fraction of the benefits telehealth offers. MM is a rare cancer and as a result, some states have few if any specialists. Maintaining telehealth policy changes made during the pandemic would remove geographical barriers and open access to specialists across the country. Citation Format: Nathan W. Sweeney, Scott R. Goldsmith, Jennifer M. Ahlstrom. Telehealth use among multiple myeloma patients during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 716.