A Focus on Phenotype and Genotype: Racial /Ethnic Disparities in Myelodysplastic Syndromes
Authors: Tinsley-Vance Sara Marie , Ali Najla Al , Ball Somedeb , Jain Akriti G , Aguirre Luis E. E. , Kaldas David , Chan Onyee , Padron Eric , Sweet Kendra , Lancet Jeffrey E. , Kuykendall Andrew T. , Sallman David A. , Komrokji Rami S. 
Published: November 2021

Abstract
Background: There is a paucity of research on racial and ethnic disparities in myelodysplastic syndromes (MDS). Research focused on racial and ethnic disparities for MDS is essential to improve knowledge and understanding to deliver racial and ethnic sensitive care. There are limited studies that delineate the incidence of cytogenetic and molecular features of MDS by race and ethnicity (Yan, et al. 2021, Ramadan, et al.,2016). The aim of this abstract is to report the difference in clinical phenotype, genotype and outcomes of White, Black and Hispanics from a large MDS data base.
Methods: Adult patients were identified through the Moffitt Cancer Center MDS data base and divided into racial/ethnic categories. Fisher exact test and chi-square tests were used to compare categorical variables. Univariate survival analysis was estimated using the Kaplan-Meier method.
Results: From analysis of 4414 patients with MDS, 4131 (93%) were White, 116 (3%) Black and 167 (4%) Hispanic. Table-1 summarizes baseline characteristics. There were more Black and Hispanic women diagnosed with MDS (p &lt; .001). Black and Hispanic patients were younger at diagnosis (p&lt;0.01), Hispanic patients had a lower platelet count at baseline (p=0.02). There were no racial differences in WHO 2016 MDS classification or disease risk according to R-IPSS. Black MDS patients had less complex karyotype (p&lt;0.05) while abnormalities in chromosome 5 were more common in White patients 785(19.6%, p&lt;0.05).
Table-2 summarizes somatic mutations (SM) landscape among the different racial groups, IDH2 SM (p=0. 01) and NPM-1 SM (p=.004) were more common in Black MDS patients. MPL (p &lt; 0.005) was observed more frequently among Hispanic patients.
There was no difference in response to any modality of treatment based on race. Hispanic patients were more likely to undergo allogeneic hematopoietic stem cell transplant 50 (29.9%, p&lt;0.01). Clinical trial participation rates among the groups were similar.
The median overall survival (mOS) was 35 months (mo), 31 mo, and 52.5 mo for White, Black and Hispanic patients respectively, p= .01 shown in Figure 1. For very low/low R-IPSS the mOS was 67.6, 52 and 93 mo respectively, p= .028, Figure 2a. For intermediate risk R-IPSS the mOS was 33, 30 and 51 mo respectively, p=0.2, and for high/very high-risk R-IPSS the mOS was 16.8, 21.7, and 25 mo respectively, p=.025. See Figures 2b and 2c. There was no difference in rate of AML transformation
Conclusions: This large retrospective study revealed racial/ethnic differences in clinical and molecular features of MDS. Hispanic patients had better overall survival. Continued research in this area is recommended to better understand the phenotype and genotype of patients from diverse ethnic/racial backgrounds.
Acknowledgement of Funding: NINR Grant # 1K23NR018488-01A
Figure 1 Figure 1.

Disclosures
Tinsley-Vance: Novartis: Consultancy; Celgene/BMS: Consultancy, Speakers Bureau; Taiho: Consultancy; Fresenius Kabi: Consultancy; Incyte: Consultancy, Speakers Bureau; Astellas: Speakers Bureau; Abbvie: Honoraria; Jazz: Consultancy, Speakers Bureau. Padron: Stemline: Honoraria; Blueprint: Honoraria; Kura: Research Funding; Taiho: Honoraria; Incyte: Research Funding; BMS: Research Funding. Sweet: Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol Meyers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; AROG: Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees. Lancet: Celgene/BMS: Consultancy; BerGenBio: Consultancy; AbbVie: Consultancy; Daiichi Sankyo: Consultancy; ElevateBio Management: Consultancy; Millenium Pharma/Takeda: Consultancy; Astellas: Consultancy; Agios: Consultancy; Jazz: Consultancy. Kuykendall: PharmaEssentia: Honoraria; Novartis: Honoraria, Speakers Bureau; Incyte: Consultancy; Prelude: Research Funding; CTI Biopharma: Honoraria; Celgene/BMS: Honoraria, Speakers Bureau; BluePrint Medicines: Honoraria, Speakers Bureau; Abbvie: Honoraria; Protagonist: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Sallman: Incyte: Speakers Bureau; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Consultancy; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Shattuck Labs: Membership on an entity's Board of Directors or advisory committees; Aprea: Membership on an entity's Board of Directors or advisory committees, Research Funding; Syndax: Membership on an entity's Board of Directors or advisory committees; AbbVie: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees; Magenta: Consultancy; Intellia: Membership on an entity's Board of Directors or advisory committees; Kite: Membership on an entity's Board of Directors or advisory committees. Komrokji: AbbVie: Consultancy; Geron: Consultancy; BMSCelgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Taiho Oncology: Membership on an entity's Board of Directors or advisory committees; PharmaEssentia: Membership on an entity's Board of Directors or advisory committees; Acceleron: Consultancy; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Jazz: Consultancy, Speakers Bureau.