Timely administration of antibiotics in febrile neutropenia per updated ASCO/IDSA guidelines

41

Background: Current ASCO guidelines for management of febrile neutropenia (FN) recommend initial antibiotic administration within one hour of triage, and initial assessment within 15 minutes of triage for patients presenting with FN within 6 weeks of chemotherapy. The University of Illinois Cancer Center (UICC) implemented an early identification and management strategy in the ambulatory setting for FN in 2017, with success in increasing the percentage of FN patients receiving antibiotics within 2 hours from 50% to 92% over a 6 months (05/2017-11/2017) period. Given updated joint ASCO/IDSA guidelines, we aimed to increase percentage of FN patients receiving antibiotics within 1 hour from 56% to more than 90% over 16 months. Methods: A multidisciplinary team involving oncology, hematology (attendings and fellows), pharmacy, and nursing met quarterly to review FN cases including time to antibiotic administration and documentation of prompt assessment. Two Plan-Do-Study-Act (PDSA) cycles were completed, including development and deployment of an electronic medical record automated order set and targeted education for fellows and nurses. Results: Between 12/17 and 04/19, of 7 patients with FN, 100% (N = 7) received antibiotics in clinic. The percentage of FN patients receiving antibiotics within 1 hour of triage post first and second interventions was as follows: 25% (N = 1), 100% (N = 4). 100% (N = 7) of FN patients had documentation of prompt assessment, but time from triage was not specified. Conclusions: We were successful in improving the percentage of FN patients receiving antibiotics from 56% to more than 90% over 16 months. We are targeting our next PDSA cycle to increase assessments within 15 minutes of triage. Additional future interventions include tailoring antibiotics based on FN with low or high risk of complication via focus group and root case analyses discussion with our attendings, fellows, and nurses, and collaborating with ED on a standard care pathway for FN management.

Survival trends among patients with metastatic melanoma in the United States: A population based study

9555

Background: Ipilimumab was approved by FDA in March 2011 for the treatment of Metastatic Melanoma. We conducted this study to compare survival outcome in patients with Metastatic Melanoma in pre- (1973-2010) and post- (2011-2013) ipilimumab era in the United States using U.S. Surveillance, Epidemiology, and End Result (SEER) registry database. Methods: We selected patients with metastatic melanoma age ≥ 20 years from the SEER database. We used SEER 18 registry database to evaluate relative survival (RS) rate during 1973-2010 and 2011-2013. The RS rate at 1year and 2 year were analyzed for cohorts by age (20-49 years, 50-74 and ≥75 years), race [White, African American (AA), and others] and gender. The RS rates (%) accompany standard error (SE). We used SEER Stat software for statistical analysis. Results: There were a total of 129,362 (106,516 and 22,846 in pre and post ipilimumab era) metastatic melanoma patients, male (n = 71,220), female (n = 58,142), white (n = 121,843), AA (n = 854) other (n = 1,315) reported in the registry. RS in pre vs post-ipilimumab era for age group 20-49 was: 96.50 ± 0.1% vs 97.20 ±0.3%, P = 0.013; and 94.10 ± 0.1% to 95.60 ±0.40, P = 0.0009; for age group 50-74 was: 94.10 ± 0.1% vs 95.30 ± 0.2%, P = 0.0001; and 90.70 ± 0.1%vs 92.90 ± 0.3%, P = 0.0001; and for age group ≥75 was 90.80 ± 0.3% vs 91.40 ± 0.7%, P = 0.23; and 85.0 ± 0.4% vs 88.10 ± 1.0%, P = 0.011 at 1 and 2 years respectively. Overall RS in pre and post ipilimumab era for white population was: 93.83 ± 0.16% vs 94.567 ± 0.4%, P = 0.017; and 90.0 ± 0.2% vs 92.033 ± 0.6%, P = 0.0008 at 1 and 2 years respectively. Similarly RS for AA was: 78.07 ± 2.93% vs 73.33 ± 8.23%, P = 0.37; and 65.87 ± 3.47% vs 65.33 ± 9.73%, P = 0.94; and for other race was: 85.2 ± 2.13% vs 77.97 ± 5.6%, P = 0.04; and 74.43 ± 5.2% vs 69.67 ± 6.7%, P = 0.1 at 1 year and 2 years. Conclusions: Our study showed that younger (20-74 years) patients with metastatic melanoma have improvement in 1 and 2-year RS rates in post ipilimumab era. Subgroup analysis by race showed no improvement in RS in AA and other races patients during this period. There was also no significant survival benefit seen in older (≥ 75 years) patients of all races and gender in post ipilimumab era.

Disparities in receipt of radiotherapy and survival by age, sex, and race among patients with nonmetastatic squamous cell carcinoma of the anus

721

Background: Combination chemoradiotherapy is the standard of care for treatment of non-metastatic squamous cell carcinoma of the anus (SCCA). This population-based study evaluated disparities in receipt of radiotherapy (RT) and its effect on survival in patients with localized and regional SCCA in the United States. Methods: The Surveillance, Epidemiology, and End Results (SEER) 18 database was used to identify patients with localized and regional SCCA diagnosed between 1998 and 2008. We used univariate and multivariate logistic regression to model the relationships between receipt of RT and age, sex, marital status, stage, and race. Relative survival rates were calculated and compared using two sample z-tests. A Cox proportional hazards model was used to find adjusted hazard ratios (HR). Results: A total of 3,971 patients with localized or regional SCCA as the only primary malignancy were included in the study, of which 3,278 (82.6%) received RT. After adjusting for covariates, those 65 years and older (adjusted OR 0.82, p=0.029) were less likely to receive RT. Females were more likely to receive RT compared to males (adjusted OR 1.54, p<0.001). We found no difference in receipt of RT by race. Comparisons of 1- and 5-year relative survival rates showed lower survival for blacks (p-value <0.01 at 1-year and <0.0001 at 5-years), those 65 years and older, and males. A 1-year survival disparity was found for those not receiving RT (p-value <0.0001 at 1-year), but no difference was observed at 5-years. A Cox proportional hazards model adjusting for all covariates showed greater hazard for blacks (adjusted HR 1.36, p=0.001), those not receiving RT (adjusted HR 1.23, p=0.03), patients 65 years or older, and males. Conclusions: This population based study identified older patients as less likely to receive RT and females as more likely to receive RT. Survival analysis identified blacks, males, older patients, and those not receiving RT as having lower rates of survival.

Improvement in survival of advanced hepatocellular carcinoma patients: Results of an updated period analysis of SEER database

383

Background: Sorafenib was approved by FDA for treatment of advanced unresectable hepatocellular carcinoma (HCC) patients in November 2007. In this study, we update survival trends in advanced HCC using Surveillance, Epidemiology, and End Results (SEER) data. Methods: We selected patients with advanced HCC diagnosed from January 2001 to December 2010 from SEER 18 registries. We excluded diagnosed at autopsy, from death certificate only, or those without survival date. We calculated 1- and 2- year relative survival rates in pre-sorafenib (2001-2007) and post-sorafenib (2008-2010) era by age, sex and ethnicity among using SEER*stat software. Results: The total number of advanced HCC patients during 2001-2010, 2001-2007 and 2008-2010 were 5,092, 2,747 and 2,345 respectively. The 1- and 2- year survival rates of patients improved significantly from pre-sorafenib era to post-sorafenib era (1 year RS: 17.20±0.7% to 19.90±0.80%, Z=2.63; 2 year RS: 8.00±0.5% to 8.7±0.60%, Z=2.31). Survival rates of male patients improved significantly in post-sorafenib era (1 year RS: 16.4±0.80 to 19.4±0.90%, Z=2.18; 1 year RS: 7.4±0.60% to 8.6±0.70%, Z=2.18). There was no improvement in survival rates of female patients. Similarly, younger patients had improvement in survival rates in post-sorafenib era compared to pre-sorafenib era (1 year Z value 2.46; 2 year Z value 2.23). There was no improvement in survival rates of older patients. Conclusions: Since FDA approval of sorafenib, survival rates of patients with advanced hepatocellular carcinoma have improved. The improvement in survival rates is limited to males and younger patients

Survival Trends among Patients with Advanced Renal Cell Carcinoma in the United States

Introduction: Since the approval of sorafenib in December 2005, several targeted therapeutic agents have been approved by the FDA for the treatment of advanced renal cell carcinoma (RCC). This study was conducted to find out whether the improvements in survival of advanced RCC patients with targeted agents have translated into a survival benefit in a population-based cohort. Methods: We analyzed the SEER 18 (Surveillance, Epidemiology and End Results) registry database to calculate the relative survival rates for advanced RCC patients during 2001-2009, 2001-2005, 2006-2007 and 2008-2009. We also evaluated the survival rates by age (<65 and ≥65 years) and sex. Results: The total number of advanced RCC patients during 2001-2009, 2001-2005, 2006-2007 and 2008-2009 were 7,047, 4,059, 1,548 and 1,440, respectively. During 2001-2009, the 1- and 3-year relative survival rates were 26.7 ± 0.6 and 10.0 ± 0.4%, respectively. There was no significant difference in 1-year relative survival rates for patients diagnosed during 2006-2007 and 2008-2009 compared to those diagnosed during 2001-2005. Similarly, the 3-year survival rates for patients diagnosed during 2006-2007 were similar to those diagnosed during 2001-2005. Conclusions: This population-based study showed that there was no significant improvement in relative survival rates among advanced RCC patients in the era of targeted agents.

Improved survival among older acute myeloid leukemia patients - a population-based study

BACKGROUND

Survival in acute myeloid leukemia (AML) has improved in younger patients over the last decade. This study was conducted to evaluate the relative survival rates in older AML patients over two decades in the US.

MATERIAL AND METHODS

We analyzed Surveillance, Epidemiology, and End Results (SEER) registry database to evaluate relative survival rate in older (≥ 75 years) AML population diagnosed during 1992-2009. We selected AML patients from 13 registries of SEER 18 database to compare RS during 1992-2000 and 2001-2009.

RESULTS

The relative survival rates improved significantly during 2001-2009 compared to 1992-2000 for all age groups and sex. For young elderly patients (75-84 years) RS increased from 13.1 ± 0.8% to 17.4 ± 0.9% at one year Z-value = 3.98, p < 0.0001 and from 2.0 ± 0.4 to 2.6 ± 0.5%, Z-value = 3.61, p < 0.0005 at five years. Similarly, for very elderly (≥ 85 years) patients RS increased from 5.3 ± 1.0% to 8.0 ± 1.0%, Z-value = 3.03, p < 0.005 at one year, but no improvement seen at five years.

CONCLUSION

The relative survival in elderly AML has increased significantly during 2001-2009 compared to 1992-2000.

Second primary malignancies in adult acute myeloid leukemia--A US population-based study

BACKGROUND

Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. Long-term survivors from AML may be at higher risk of second primary malignancies.

PATIENTS AND METHODS

We selected adult patients with AML aged≥18 years from the National Cancer Institute's Surveillance, Epidemiology and End RESULTS (SEER 13) database. We used the multiple primary standardized incidence ratio session of SEER*stat software to calculate the risk of second primary malignancies in patients with AML.

RESULTS

Among 5,091 patients, 148 patients developed a total of 160 second primary malignancies, with an observed/expected (O/E) ratio of 1.17, (95% confidence interval=0.99-1.36), and an excess risk of 15.47 per 10,000 population. The risk of all-site cancer, cancer of gastrointestinal system, and oral and pharyngeal cancer in different age groups was found to be significantly higher among patients with AML compared to that of general US population.

CONCLUSION

Adult patients with AML have a significantly higher risk of second primary malignancies compared to the general population.

Second primary malignancies in chronic myeloid leukemia

Survival of patients with chronic myeloid leukemia (CML) has improved with the use of imatinib and other tyrosine kinase inhibitors. There is limited data on second primary malignancies (SPM) in CML. We analyzed the SPMs rates among CML patients reported to Surveillance, Epidemiology, and End Results (SEER) database during pre-(1992-2000) and post-(2002-2009) era. We used SEER Multiple Primary-Standardized Incidence Ratio session to calculate standardized incidence ratios (SIRs). Among 8,511 adult CML patients, 446 patients developed 473 SPMs. The SIR for SPMs in CML patients was significantly higher with observed/expected ratio:1.27, P < 0.05 and absolute excess risk of 32.09 per 10,000 person years compared to general population. The rate of SPMs for cancers of all sites in post-imatinib era were significantly higher compared to pre-imatinib era with observed/expected ratio of 1.48 versus 1.06, P = 0.03. This study showed that risk of SPMs is higher among CML patients. The risk of SPMs is significantly higher in post-imatinib era compared to pre-imatinib era.

Implications of rapidity of response to initial therapy in multiple myeloma

8606

Background: The rapidity of response to initial therapy in multiple myeloma (MM) depends on a variety of factors. There is limited data on its implications on long term outcomes in patients (pts) with newly diagnosed MM. Methods: We retrospectively examined the outcomes in a cohort of 454 pts with newly diagnosed MM between Jan 2000- Dec 2011 undergoing induction therapy. Results: The median age at diagnosis was 66 yrs (29-92). Pts had measurable serum M-spike (>= 1 g/dL), dFLC (>=10 mg/dl) or 24 hour urinary M protein excretion (UrM; >=200 mg) in 70, 63 and 39% respectively. We first examined the relationship between the response to first cycle of therapy and overall survival (OS). We divided pts into quartiles based on their % reduction in the serum M spike, dFLC or UrM. The median OS (Table) was poorest for pts with the least reduction of serum M protein (P<0.001) and of dFLC. The cutoffs for Q1 was 25, 40and 40% decrease for serum M spike, dFLC and 24 hr UrM respectively. Among various baseline characteristics only higher age was predictive of a poor (Q1) response. Given the trend toward worse OS among the Q 4 group (maximum decrease in serum M spike), we examined the relationship to cytogenetic risk. Among 232 pts with FISH data available, proportion of pts with high-risk disease was 27, 12, 22 and 31% respectively in quartiles 1 - 4). In a multivariate analysis, quartile 1 and 4 of serum M-protein response and the high-risk FISH were independent risk factors associated inferior OS. Conclusions: Both shallow and very deep response to therapy in cycle 1 is a strong indicator of eventual disease outcome and should be considered as marker of high-risk disease, likely through different mechanisms. For the shallow responders, prospective trials should assess if a change in therapeutic management will alter the outcome of these pts. The rapid deep responders also appear represent a different high-risk biology, emphasizing the fact that pts with high-risk disease often have excellent initial responses, but poor long term outcomes. [Table: see text]

Survival trends among patients with acute myeloid leukemia in the United States

e17598

Background: The chemotherapy regimen for acute myeloid leukemia (AML) has not changed significantly over the last two decades. Better patient care may have improved survival in AML patients. This study was conducted to evaluate the relative survival rates in AML patients over two decades in the United States. Methods: Adult patients (age≥20 years) diagnosed with AML were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Several cohorts categorized by race (Caucasians & African-Americans (AA)), gender & age (20-59, ≥60 years) were compared to see survival differences from 1992-2000 & 2001-2009. We used SEER Stat software to calculate 1- and 5-year relative survival rates (RS). The survival rates accompany standard errors. Results: The database comprised of 28,217 patients. The relative survival rates of AML improved significantly during 2001-2009 compared to 1992-2000 1-year 39.2±0.4 vs 33.7±0.5,( Z score 9.079, p<0.0005); 5- year 20.1±0.4 vs 15.3±0.4, (Z score 10.357, p<0.0005). The 1-and 5-year RS for men during 1992-2000 vs 2001-2009 were 32.3±0.7% vs 39.2±0.5% (Zscore=8.392, p<0.0005) & 13.9±0.5% vs 18.7±0.5% (Zscore= 8.710, p<0.0005) respectively. For women, the survival rates during 1992-2000 vs 2001-2009 were 35.3±0.7% vs 39.1±0.5% (Zscore=4.318, p<0.0005) at 1-year & 16.9±0.6% vs 21.7±0.5% (Z score=5.917, p<0.0005) at 5-years. For younger patients (<60 years), relative survival rates at during 1992-2000 and 2001-2009 were: 1- year: 56.7±0.9 vs 63.5±0.6, (Z score=6.462, p<0.0005); 5- year: 33.0±0.8 vs 40.6±0.7, (Z score= 7.070, p <0.0005). Similarly, the survival rates were significantly better for older patients and for all ethnic groups during 2001-2009 compared to 1992-2000. Conclusions: The relative survival in AML has increased significantly during 2001-2009 compared to 1992-2000. This may be secondary to improvement in supportive care.

Differences in colon cancer incidence rates by latitude

e14627

Background: There is significant decrease in the ultraviolet B photons reaching the earth’s surface during November to February (Holick MF Am J Clin Nutr. 2004 Dec; 80(6 Suppl):1678S-88S). This results in little if any vitamin D3 production in the skin during this period. This study was conducted to evaluate difference in colon cancer age adjusted incidence rates in the northern (latitude ≥37o N) and the southern (latitude < 37oN) regions in the contiguous United States during 1973-2008. Methods: Patients, aged 20 years and older, who had been diagnosed with colong cancer during January 1973 and December 2008, were selected from the Surveillance, Epidemiology, and End Results (SEER) 13 database. Based on the counties’ centroid, northern (latitude ≥37o N) and southern (latitude < 37oN) regions were determined. We compared age adjusted incidence rates (AAIR) of colon cancer in the southern and northern regions among cohorts of patients categorized by age (≥20, 20-64, ≥65 years), gender (Men, Women) and Race (Caucasians, Blacks, Others). The AAIR was calculated per 100,000 population. We used SEER*Stat software to calculate age adjusted incidence rate, incidence ratio, confidence interval (CI, 95%) and P value. Results: There were 314,975 cases of colon cancer diagnosed among 608,245,557 US population during 1973-2008. The overall colon cancer AAIR was 57.1 per 100,000 population studied. The incidence rates were 49.1 in the south and 58.7 in the north of 37oN latitude, (95% CI 1.18-1.20, p<0.05). The AAIRs for patients in the age group 20-64 years were 17.9 and 18.8 in the southern and northern regions, (CI 95%, 1.0346-1.0697), p<0.0005 respectively. The incidence rates for patients aged ≥65 years were 194.3 and 243.9 in the southern and northern regions, (CI 95%, 1.0346-1.0697) p<0.0005. Similarly, the AAIRs were significantly higher in the northern region compared to southern region for both sexes and all ethnic groups. Conclusions: Colon cancer age-adjusted incidence rate is significantly higher in the Northern compared to the Southern region of the US. The higher incidence of colon cancer in the North may be related to lack of sunlight exposure and relative vitamin D deficiency.

Second primary malignancies in acute myeloid leukemia

e20529

Background: Long-term survival rate in acute myeloid leukemia (AML) patients younger than 60 yrs is higher than 40% (Mayer RJ, et al N Engl J Med 2004). Development of second primary malignancy (SPM) in these patients is unknown. We analyzed the incidence of SPM in these AML patients using SEER database. Methods: We analyzed the Surveillance, Epidemiology, and End Results (SEER*Stat) database: Incidence - SEER 13 Regs Research Data, Nov 2011 Sub, Vintage 2009 Pops (1992-2009) using multiple primary standardized incidence ratio (MP-SIR) session. We evaluated SPM incidence rate among adult AML patients (age 20-59 yrs) during the period 1992 - 2009. We used SEER*Stat software for statistical analysis. Results: Total number of AML patients (age 20-59 yrs) reported during 1992-2009 period was 5,544. Median age at the time of diagnosis of SPM was 54.33 yrs ( 22.33-72.42 yrs). Median follow up was 8.13 yrs (2months – 17.8 yrs) and median latency period was 51 months ( 2-193months). The total number of all site SPM among AML patients reported during same time period was 100 with observed/expected (O/E) ratio of 1.03, (95% CI: 0.84-1.26), excess risk of 1.62 per 10,000 population. Ninety patients with AML developed SPM; 86 AML patients developed only 1 SPM and 7 patients developed 2 SPMs. The risk of oral cavity and pharyngeal cancer was significantly increased in AML patients with O/E: 3.99, p<0.05 (95% CI: 1.99-7.15), excess risk of 3.98 per 10,000 population. Similarly, cancer of urinary system was significantly increased in AML patients with O/E: 2.26, p<0.05 (95% CI: 1.23-3.79), excess risk of 3.77 per 10,000 population. Conclusions: This study showed significantly higher risk of second primary malignancies of oral cavity/pharyngeal cancer, and of urinary system in AML patients. [Table: see text]

Survival trends among patients with advanced renal cell carcinoma (RCC) in the United States

422

Background: Since approval of sorafenib in December 2005, several targeted therapeutic agents have been approved by the FDA for the treatment of advanced renal cell carcinoma. This study was conducted to find out whether the improvements in survival of advanced RCC patients with targeted agents have translated into survival benefit in population-based cohort. Methods: We analyzed the Surveillance, Epidemiology, and End Results (SEER) 18 registry database to compare 1- and 3-year relative survival rates among advanced RCC patients during 2001-2009, 2001-2004, and 2006-2009. We also evaluated the survival rates by age (<65 and ≥65 years) and sex. We used SEER*Stat software to analyze the data. Results: The total number of advanced RCC patients during 2001-2009, 2001-2004, and 2006-2009 were 7,055, 3,355 and 2,985 respectively. During 2001-2009, the 1- and 3-year relative survival rates were 26.7± 0.6% and 10.0±0.4% respectively. The 1-year relative survival rates during 2001-2004 and 2006-2009 were 27.0±0.8% and 27.1±0.9%, (p value=1.3) respectively. Similarly, the 3-year survival rates during 2001-2004 and 2006-2009 were 10.1±0.6% and 9.6±0.8%, (p value=1.42), respectively. There was no significant difference in survival rates during 2001-2004 and 2006-2009 periods by age and sex. Conclusions: This population based study showed that there was no significant improvement in relative survival rates among advanced RCC patients in the era of targeted agents. As with other database analyses, limitations of this large study may be incomplete reporting practices and lack of data on treatment.

Survival trends among patients with advanced hepatocellular carcinoma in the United States

329

Background: Sorafenib was approved by FDA for treatment of HCC in 2007. This study was conducted to evaluate survival outcome in advanced HCC during 2005-2006 and 2008-2009 using U.S. Surveillance, Epidemiology, and End Results (SEER) cancer registry database.Methods: We analyzed the Surveillance, Epidemiology, and End Results (SEER*Stat) database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2011 Sub (1973-2009 varying) using MP-SIR session. We analysed 1 year relative survival rates among stage IV HCC patients between pre- sorafenib (2005- 2006) and post- sorafenib (2008- 2009) eras. We used seer Z test to compare relative survival rates among cohorts of patients categorized by gender and age groups (<50 and >50 years). Results: There were 2,497 (1,180 in pre-sorafenib era and 1,317 in post-sorafenib era) stage IV HCC patients reported in seer database. Overall 1 year relative survival rates ± standard error (SE) were: 12.5±0.7% (12.5±1% in pre sorafenib era vs 13.1±1.1% in post sorafenib era, Z score= 0.481, p value=0.63). Overall Relative survival rates among men and women were 12.9±0.8% (12.7±1.1% in pre vs 13.4±1.2 in post sorafenib era, Z score=0.254, p value=0.79) and 11.8±1.6% (11.7±2.2% in pre vs 11.5±2.5 post sorafenib era, Z score=0.469, p value=0.63) respectively. There was no significant differences between 1 year relative survival rates by age groups (<50 and >50 years). Conclusions: This study showed no significant difference in 1-year relative survival rates during 2008-2009 as compared to 2005-2006. More studies are required to find out why the findings of SHARP trial have not translated to population-based settings.[Table: see text]

Analysis of second primary cancers in gastroinstestinal stromal tumor patients using SEER database

327

Background: Development of second primary cancers among gastrointestinal stromal tumor (GIST) patients is not very well studied. This study was conducted to evaluate second primary malignancies in GIST patients using U.S. Surveillance, Epidemiology, and End Results (SEER) cancer registry database. Methods: We analyzed the Surveillance, Epidemiology, and End Results (SEER Stat) database: Incidence - SEER 13 Regs Research Data, Nov 2011 Sub, Vintage 2009 Pops (1992-2009) using MP-SIR session. We analysed secondary cancer rate among adult GIST patients during the period 1992-2009. We also compared the risk of secondary malignancies in pre- (1992-2001) to post-imatinib (2002-2009) eras. We used SEER MP-SIR session and Graph pad scientific software to calculate p value. Results: There were 2,436 (693 in pre-imatinib era and 1,743 in post-imatinib era) GIST patients reported during 1992-2009 period in SEER database. Among them, 163 GIST patients developed second primary malignancy, which is significantly higher than expected in general population, with observed/expected (O/E) ratio: 1.31, p value = <0.05, (95% CI: 1.11-1.52) and excess risk of 39.76 per 10,000 population. The total number of second primary cancers in GIST in pre- and post-imatinib eras were 69 and 94, p value = <0.0001 with observed/expected (O/E) ratio of 29.18 and 48.22 respectively. The total number of second primary solid tumors in pre- and post-imatinib era was: 59 and 84, p value=0.0008 and O/E ratio: 20.18 vs 43.32 respectively. Conclusions: This study showed overall increased risk of second primary malignancies among GIST patients as compared to general population. There was significantly increased risk of second primary malignancies, especially solid tumors in post-imatinib era. [Table: see text]