Batra, Nitya

484 Background: Renal cell carcinoma (RCC) is the most common type of urogenital cancer. Lifestyle and metabolic risk factors seem to play an important role in this rising incidence. Glucagon-like peptide-1 (GLP-1) receptor agonists are widely used for the treatment of type 2 diabetes and obesity. Emerging evidence suggests that these agents may have potential anti-tumor activity as GLP-1 signaling may influence pathways involved in cell proliferation and inflammation. Our study aims to evaluate the impact of GLP-1 receptor agonists on outcomes among patients with RCC and comorbid obesity. Methods: A retrospective cohort study was conducted using the US Collaborative Network TriNetX, covering January 2000 to December 2023, encompassing data from 105 global healthcare organizations. Adult patients aged 18 and above with RCC and comorbid obesity were identified and then stratified into two groups based on treatment with GLP-1 agonists or not. The two groups were then propensity-matched based on age, race, and common comorbidities. We followed these patients for 5 years to assess outcomes, including overall mortality, myocardial infarction, heart failure, ischemic stroke, chronic kidney disease (CKD), metabolic dysfunction-associated steatotic liver disease (MASLD), and need for hemodialysis. Results: We identified 2232 patients with RCC and obesity who received GLP-1 receptor agonists, and 13090 patients with RCC and obesity who did not receive GLP-1 therapy. After propensity matching, each cohort consisted of 2231 patients with similar baseline characteristics. Our analysis found that over 5 years, patients with RCC and obesity who received GLP-1 receptor agonists had a significantly lower risk of overall mortality (Hazard Ratio (HR): 0.493, 95% CI: 0.427 to 0.57, p-value < 0.001), myocardial infarction (Risk Difference: -2.239%, 95% CI: -3.836 to -0.642, p-value = 0.006), heart failure (Risk Difference: -4.213%, 95% CI: -6.876 to -1.551, p-value = 0.002), ischemic stroke (ischemic stroke: -2.111%, 95% CI: -3.44 to -0.781, p-value = 0.002), and CKD (Risk Difference: -8.526%, 95% CI: -11.441 to -5.611, p-value < 0.001). There was no statistically significant difference in the risk for MASLD and need for hemodialysis between the two subgroups. Conclusions: Our study revealed that patients with RCC and obesity who received GLP-1 receptor agonists had a significantly lower risk of mortality, myocardial infarction, heart failure, CKD and ischemic stroke. Further longitudinal cohort studies are imperative to better understand these associations and guide evidence-based clinical practice in this population.

Abstract Introduction: Breast cancer most commonly metastasizes to the bones, with bone pain and other skeletal related events (SREs) having a limiting effect on quality of life. Bisphosphonates are widely used in breast cancer patients to reduce SREs and bone loss, particularly in those with bone metastases or receiving endocrine therapy. We aim to study the real world comparative data between two widely used bisphosphonates in clinical practice, zoledronic acid and pamidronate, along with evaluation of their toxicity profiles. Methods: A retrospective cohort study was conducted using the US Collaborative Network TriNetX, covering January 2000 to December 2023, and encompassing data from 105 global healthcare organizations. Female patients aged 18 and above with breast cancer metastatic to the bone were identified and then stratified into two groups based on treatment with zoledronic acid or pamidronate. The two groups were then propensity-matched based on age, sex, race, and comorbidities. We followed these patients for 5 years to assess outcomes, including mortality, osteoporotic fracture, hypercalcemia, pathological fracture, fall, and osteonecrosis. Results: We identified 7887 patients in the zoledronic acid cohort and 635 patients in the pamidronate cohort. After propensity matching, each cohort consisted of 625 patients with similar baseline characteristics. The average age was 66.4 years in zoledronic acid cohort and 69.1 in the pamidronate cohort. In the zoledronic acid cohort, the ethnicity distribution was 74.68 % White, 11.55% African American, and 6.36% Hispanic. In contrast, the pamidronate group had an ethnicity distribution of 63.04% White, 20.64% African American, and 8.16% Hispanic. Our analysis found that within 5 years, patients with breast cancer metastatic to the bone who received zoledronic acid had a significantly lower risk of mortality (Hazard Ratio [HR] 0.593, 95% CI: 0.509-0.691, p-value &lt;0.001), osteoporotic fracture (Risk difference: -5.28%, 95% CI: -7.65 to -2.90), p-value &lt; 0.001), hypercalcemia [HR: 0.262, 95% CI: 0.212 - 0.323, p-value = 0.001), pathological fracture (Risk difference: -6.88%, 95% CI: -10.69 to -3.07), p-value &lt; 0.001). However, the zoledronic acid group had higher risk of falls [Risk difference: 3.52%, 95% CI: 0.518 to 6.522), p-value = 0.021). There was no statistically significant difference in the occurrence of osteonecrosis between the two cohorts. Conclusion: Our study revealed that patients with breast cancer with metastatic disease to the bone who received zoledronic acid had significantly lower rates of mortality, osteoporotic fracture, hypercalcemia, and pathological fracture compared to those receiving pamidronate. Additional longitudinal cohort studies are imperative to explore the outcomes between these agents and inform clinical practice guidelines. Citation Format: Y. Arya, A. Syal, C. Jones, H. Mahadevia, N. Batra, A. Uriepero-Palma. Real-world outcomes comparing zoledronic acid and pamidronate in patients with metastatic breast cancer with bone metastases: A propensity score matched analysis from a global federated health research network [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-06-02.

Abstract Introduction: Patients with metastatic breast cancer frequently develop bone metastases and experience other skeletal-related events (SREs). These complications substantially impair quality of life and may negatively influence clinical outcomes. In this context, bisphosphonates and denosumab are the most commonly utilized therapeutic agents. We aim to study the real-world comparative data between bisphosphonates and denosumab in breast cancer patients with bony metastases along with evaluation of their toxicity profiles. Methods: A retrospective cohort study was conducted using the US Collaborative Network, TriNetX, covering January 2000 to December 2023, encompassing data from 105 global healthcare organizations. Female patients aged 18 and above with breast cancer metastatic to the bone were identified and then stratified into two groups based on treatment with zoledronic acid or pamidronate. The two groups were then propensity-matched based on age, sex, race, and comorbidities. We followed these patients for 5 years to assess outcomes, including mortality, osteoporotic fracture, hypercalcemia, pathological fracture, fall, and osteonecrosis. Results: We identified 7887 patients in the zoledronic acid cohort and 635 patients in the pamidronate cohort. After propensity matching, each cohort consisted of 625 patients with similar baseline characteristics. The average age was 66.4 years in the zoledronic acid cohort and 68.5 in the denosumab cohort. In the zoledronic acid cohort, the ethnicity distribution was 74.68 % White, 6.36% Hispanic, and 11.55% African American. In comparison, the denosumab group had an ethnicity distribution of 74.49% White, 10.31% African American, and 5.68% Hispanic. Our analysis found that within 5 years, patients with breast cancer metastatic to the bone who received zoledronic acid had a significantly lower risk of mortality (Risk difference: -3.49%, 95% Confidence Interval [CI]: -5.063 to -1.916), p-value &lt;0.001) compared to denosumab. However, patients in the zoledronic acid arm were noted to have a higher risk of osteoporotic fracture (Risk difference: 0.817%, 95% CI: 0.232 to 1.402), p-value = 0.006), hypercalcemia [Hazard Ratio [HR]: 1.524, 95% CI: 1.407 to 1.65, p-value &lt;0.001), and pathological fracture (HR: 1.501, 95% CI: 1.349 to 1.671), p-value =0.03). There was no significant difference in the occurrence of falls and osteonecrosis between the two subgroups. Conclusion: Our study revealed that patients with breast cancer with metastatic disease to the bone who received zoledronic acid had significantly lower rates of mortality but higher occurrence of osteoporotic fracture, hypercalcemia, and pathological fracture compared to those receiving denosumab. Additional longitudinal cohort studies are imperative to explore the outcomes between these agents and inform clinical practice guidelines in these patients. Citation Format: A. Syal, Y. Arya, C. Jones, H. Mahadevia, N. Batra, A. Uriepero Palma. Real-world outcomes comparing zoledronic acid and denosumab in patients with metastatic breast cancer and bone metastases: A propensity score matched analysis from a global federated health research network [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-08-17.

83 Background: Colon cancer is among the leading causes of cancer-related morbidity and mortality globally, with an increasing incidence observed in younger populations. Lifestyle and metabolic risk factors seem to play an important role in this rising incidence. Glucagon-like peptide-1 (GLP-1) receptor agonists are widely used for the treatment of type 2 diabetes and obesity. Emerging evidence suggests that these agents may have potential anti-tumor activity as GLP-1 signaling may influence pathways involved in cell proliferation and inflammation. Our study aims to evaluate the impact of GLP-1 receptor agonists on outcomes among patients with colon cancer with comorbid obesity, exploring potential interactions between metabolic modulation and disease behavior. Methods: A retrospective cohort study was conducted using the US Collaborative Network TriNetX, covering January 2000 to December 2023, encompassing data from 105 global healthcare organizations. Adult patients aged 18 and above with colon cancer and comorbid obesity were identified and then stratified into two groups based on treatment with GLP-1 agonists or not. The two groups were then propensity-matched based on age, sex, race, and common comorbidities. We followed these patients for 5 years to assess outcomes, including overall mortality, myocardial infarction, sepsis, acute pancreatitis, need for mechanical ventilation and hemodialysis. Results: We identified 1986 patients with colon cancer and obesity who received GLP-1 receptor agonists, and 16384 patients with colon cancer and obesity who did not receive GLP-1 therapy. The average age was 68.8 years in the first cohort and 74.3 years in the second cohort. After propensity matching, each cohort consisted of 1983 patients with similar baseline characteristics and ethnicity distribution. Our analysis found that over 5 years, patients with colon cancer and obesity who received GLP-1 receptor agonists had a significantly lower risk of overall mortality (Hazard Ratio (HR): 0.461, 95% CI: 0.401 to 0.532, p-value < 0.001), myocardial infarction (HR: 0.827, 95% CI: 0.668 to 0.993, p-value =0.005), sepsis (Risk Difference: -3.48%, 95% CI: -4.774 to -2.185, p-value < 0.001), and need for mechanical ventilation (HR: 0.486, 95% CI: 0.321 to 0.739, p-value = 0.037). There was no statistically significant difference in the risk of acute pancreatitis and need for hemodialysis between the two subgroups. Conclusions: Our study revealed that patients with colon cancer and obesity who received GLP-1 receptor agonists had a significantly lower risk of mortality, myocardial infarction, sepsis, and need for mechanical ventilation. Further longitudinal cohort studies are imperative to better understand these associations and guide evidence-based clinical practice in this population.

517 Background: Hepatocellular carcinoma (HCC) is a major cause of cancer related morbidity and mortality worldwide, with increased incidence in patients with chronic liver disease, obesity and metabolic syndrome. Of note, increasing burden of metabolic dysfunction-associated steatohepatitis (MASH) and non-alcoholic fatty livery disease (NAFLD) has contributed to increased incidence of cirrhosis and progression to HCC. Glucagon-like peptide-1 (GLP-1) receptor agonists are widely used for the treatment of type 2 diabetes and obesity. Their pleotropic benefits including improved insulin sensitivity, potential anti-proliferative and anti-inflammatory benefits may significantly benefit these patients by potentially reduced hepatic inflammation and steatosis. Our study aims to evaluate the impact of GLP-1 receptor agonists on outcomes among patients with hepatocellular carcinoma with comorbid obesity, exploring potential interactions between metabolic modulation and disease behaviour. Methods: A retrospective cohort study was conducted using the US Collaborative Network TriNetX, covering January 2000 to December 2023, encompassing data from 105 global healthcare organizations. Adult patients aged 18 and above with HCC and comorbid obesity were identified and then stratified into two groups based on treatment with GLP-1 agonists or not. The two groups were then propensity-matched based on age, sex, race, and common comorbidities. We followed these patients for 5 years to assess outcomes, including overall mortality, myocardial infarction, acute pancreatitis, sepsis, need for mechanical ventilation and hemodialysis. Results: We identified 401 patients with HCC and obesity who received GLP-1 receptor agonists, and 3974 patients with HCC and obesity who did not receive GLP-1 therapy. The average age was 63.7 years in the first cohort and 61.4 years in the second cohort. After propensity matching, each cohort consisted of 399 patients with similar baseline characteristics and ethnicity distribution. Our analysis found that over 5 years, patients with HCC and obesity who received GLP-1 receptor agonists had a significantly lower risk of overall mortality (Hazard Ratio (HR): 0.48, 95% CI: 0.371 to 0.623, p-value = 0.001). There was no statistically significant difference in the risk for myocardial infarction, acute pancreatitis, sepsis, need for mechanical ventilation and hemodialysis between the two subgroups. Conclusions: Our study revealed that patients with HCC and obesity who received GLP-1 receptor agonists had a significantly lower risk of mortality. Further longitudinal cohort studies are imperative to better understand these associations and guide evidence-based clinical practice in this population.

402 Background: Trastuzumab deruxtecan (T-DXd) is a HER2-targeted antibody-drug conjugate (ADC) with a cytotoxic payload. TDXd was approved in 2021 to be used in advanced gastric or GEJ cancers. Although given the recent approval, real-world evidence on efficacy and safety is limited. We sought to evaluate the efficacy and safety of T-DXd through a combined meta-analysis of clinical trials and real-world studies. Methods: A comprehensive search was conducted across PubMed, Embase, Scopus, and Clinicaltrials.gov databases. The original studies evaluating T-DXd in patients with metastatic/recurrent gastric/gastroesophageal junction (GEJ) cancers were included in the analysis. The pooled objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and the incidence of adverse events (AEs) were analyzed. A random-effects model was used for meta-analysis, and the heterogeneity of the data was evaluated by Chi-sq Q test and the I 2 statistic using OpenMeta [Analyst] (Tufts Medical Center, Boston, MA, USA). Results: This meta-analysis incorporated 8 studies (3 phase II clinical trials, 5 retrospective studies) comprising 915 patients with advanced HER2-positive gastric/GEJ cancer. The median patient age was 66.5 years (range: 27–89), with 75.4% males, 70.4% Asian, and 29.0% Caucasians. 77.9% had an ECOG performance status of 0–1, while 21.8% had ECOG ≥2. Histologically, 53.6% had intestinal and 22.9% diffuse-type adenocarcinoma. HER2 overexpression (IHC3+) was observed in 75.8% of evaluable cases, and 22.4% were IHC2+/FISH positive. 77.6% had primary gastric and 22.4% GEJ tumors. The median line of therapy was 3 (range: 2–11), with prior immune checkpoint inhibitor use in 31.8% and prior surgery in 44.5% .The pooled ORR was 47.7% (95% CI 43.0-52.4%) and DCR was 82.50% (79.40%–85.72%); PFS and OS were 4.92 and 9.86 months, respectively. Safety analysis revealed grade ≥3 AEs in 48.2% of patients, neutropenia (24.5%) being the most common. Treatment discontinuation due to adverse events occurred in 12.2%, and dose reductions were required in 21.5%. Patient-reported outcomes were not assessed in any of the studies. Conclusions: Our meta-analysis, encompassing both clinical trials and real-world data, confirms the encouraging efficacy of T-DXd in gastric/GEJ cancers, with a pooled ORR of 47.7% and a median PFS of 4.92 months, and supports its use as an early-line treatment in this challenging disease landscape. This analysis also highlights the significant incidence of grade ≥3 AEs, particularly neutropenia, which necessitates vigilant monitoring and proactive management. Future research should focus on optimizing patient selection, exploring combination therapies, and refining dosing strategies to maximize clinical benefit while mitigating toxicity.

Abstract Background: B-cell acute lymphoblastic leukemia (B-ALL) accounts for 0.3% of all new cancer cases and 0.2% of cancer-related deaths in the United States. While survival outcomes have improved over the years, further intensifying chemotherapy has offered diminishing returns. Blinatumomab, a bispecific T-cell engager targeting CD3 and CD19, has shown clinical benefit in minimal residual disease (MRD)-positive and relapsed/refractory settings. Its recent FDA approval for use in the consolidation phase of newly diagnosed Philadelphia chromosome–negative, CD19-positive B-ALL followed the landmark E1910 trial, which demonstrated a survival advantage when added to standard chemotherapy. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of blinatumomab in the consolidation phase across clinical trials and real-world studies. Methods: A comprehensive review was carried out on PubMed, Clinicaltrials.gov and Cochrane library from inception up to July 2025 using the terms “Blinatumomab” and “ALL”. Studies that evaluated response: overall response rate (ORR) and complete response (CR) and adverse events between Blinatumomab and control groups were included. Out of the 19 studies that met the inclusion criteria, 12 were clinical trials and 7 were observational studies. Open meta-analyst software was used to analyze the data. For single arm study, PLO (logit-transformed proportion) was used as a metric. Der Simonian-Laird random effects model was used to generate forest plots of pooled response rate estimates and 95% CI along with p-values and I2 statistics for heterogeneity. Results: A total of 824 patients were included (54.4% male, 45.6% female), with a median age of 48 years. The median follow-up across studies was 18.2 months (range, 3.4 to 92.8 months). Pooled ORR was 96.4% (95% CI, 93–98; p=0.955), and pooled CR was 92.7% (95% CI, 87–95; p&lt;0.001). TRAEs leading to treatment discontinuation occurred in 6.8% (95% CI, 2.5–11.2; p=0.004), dose reductions in 2.9% (95% CI, 0.2–5.6; p=0.069), and treatment-related mortality in 1.4% (95% CI, 0.4–2.3; p=0.256). There was moderate heterogeneity across studies for toxicity outcomes. Conclusion: Consolidation-phase blinatumomab is associated with high response rates and a favorable safety profile, reinforcing the survival gains observed in E1910 (3-year OS: 83% vs 65%). With low rates of treatment-limiting toxicity and mortality, our findings support the incorporation of blinatumomab into standard adult B-ALL consolidation regimens. These data suggest that this immunotherapeutic approach may help narrow the outcome gap between adult and pediatric ALL.

Abstract Introduction Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease that often requires hospitalization and urgent intervention. Hospitalized patients may present with multiple acute conditions necessitating glucocorticoid therapy. Although glucocorticoids are well known for their anti-inflammatory effects, their use in ACS remains controversial due to concerns about worsening of underlying infection, progression to sepsis, and subsequent respiratory failure. This study aims to evaluate the impact of concomitant glucocorticoid use on clinical outcomes in patients with ACS. Methods A retrospective cohort study was conducted using the US Collaborative Network TriNetX, covering January 2000 to December 2023, encompassing data from 105 global healthcare organizations. Adult patients aged 18 and above with acute chest syndrome were identified and then stratified into two groups based on treatment with glucocorticoids during the index hospitalization or not. The two groups were then propensity-matched based on age, sex, race, and comorbidities. We followed these patients for 5 years to assess outcomes, including overall mortality, simple transfusions, exchange transfusions, need for mechanical ventilation, incidence of pneumonia, influenza, sepsis without shock, sepsis with shock, and need for hemodialysis. Results We identified 4197 patients in the acute chest syndrome with glucocorticoids cohort and 8211 patients in the acute chest syndrome without glucocorticoids cohort. After propensity matching, each cohort consisted of 4111 patients with similar baseline characteristics. Our analysis found that over 5 years, patients with acute chest syndrome who received glucocorticoids during the index hospitalization had a significantly higher risk of overall mortality (Hazard Ratio (HR): 1.361, 95% CI: 1.158 to 1.599, p-value &lt;0.001), simple transfusions (HR: 2.191, 95% CI: 2.015 to 2.381, p-value =0.009), exchange transfusions (Risk difference: 0.008, 95% CI: 0.003 to 0.013, p-value =0.001), need for mechanical ventilation (Risk difference: 0.024, 95% CI: 0.016 to 0.032, p-value &lt;0.001), pneumonia (HR: 1.190, 95% CI: 1.111 to 1.276, p-value =0.004), influenza (Risk difference: 0.044, 95% CI: 0.029 to 0.059, p-value &lt;0.001), sepsis without shock (Risk difference: 0.016, 95% CI: 0.007 to 0.024, p-value &lt;0.001), and sepsis with shock (Risk difference: 0.026, 95% CI: 0.018 to 0.034, p-value &lt;0.001). There was no statistically significant difference in the need for hemodialysis between the two subgroups. Conclusion Our study found that patients with acute chest syndrome who were exposed to glucocorticoids during the index hospitalization had a significantly increased risk of overall mortality, simple transfusions, exchange transfusions, need for mechanical ventilation, incidence of pneumonia, influenza, sepsis without shock, and sepsis with shock. Further longitudinal cohort studies are imperative to better understand these associations and guide evidence-based clinical practice in this population.

Abstract Introduction Glucagon-like peptide-1 (GLP-1) receptor agonists are widely used for the treatment of type 2 diabetes and obesity. Emerging evidence suggesting their potential anti-inflammatory and anti-proliferative effects as well as cardiovascular benefits. Chronic myeloid leukemia (CML), a myeloproliferative neoplasm, has seen major therapeutic advances with tyrosine kinase inhibitors (TKIs). However, metabolic comorbidities remain widely prevalent in these patients due to both cancer-associated risk factors and the effects of therapy. Our study aims to evaluate the impact of GLP-1 receptor agonists on outcomes among patients with CML, exploring potential interactions between metabolic modulation and disease behaviour. Methods A retrospective cohort study was conducted using the US Collaborative Network TriNetX, covering January 2000 to December 2023, encompassing data from 105 global healthcare organizations. Adult patients aged 18 and above with CML and comorbid obesity were identified and then stratified into two groups based on treatment with GLP-1 agonists or not. The two groups were then propensity-matched based on age, sex, race, and comorbidities. We followed these patients for 5 years to assess outcomes, including overall mortality, myocardial infarction, ischemic stroke, sepsis, and need for mechanical ventilation and hemodialysis. Results We identified 701,767 patients with CML and obesity who received GLP-1 receptor agonists, and 6,811,928 patients with CML and obesity who did not receive GLP-1 therapy. After propensity matching, each cohort consisted of 700,998 patients with similar baseline characteristics. Our analysis found that over 5 years, patients with CML and obesity who received GLP-1 receptor agonists had a significantly lower risk of overall mortality (Hazard Ratio (HR): 0.509, 95% CI: 0.501 to 0.518, p-value &lt;0.001), myocardial infarction (HR: 0.785, 95% CI: 0.769 to 0.801, p-value &lt;0.001), ischemic stroke (HR: 0.665, 95% CI: 0.632 to 0.700, p-value &lt;0.001), hemodialysis (HR: 0.445, 95% CI: 0.430 to 0.461, p-value &lt;0.001) and sepsis (HR: 0.726, 95% CI: 0.714 to 0.738, p-value &lt;0.001). There was no statistically significant difference in the need for mechanical ventilation between the two subgroups. Conclusion Our study revealed that patients with CML and obesity who received GLP-1 receptor agonists had a significantly lower risk of mortality, myocardial infarction, ischemic stroke, hemodialysis and sepsis. Further longitudinal cohort studies are warranted to better understand these associations and inform clinical practice guidelines.

Abstract Introduction: BL and DLBCL are the two most common lymphomas associated with HIV infection. Notably, clinical trials often exclude HIV-positive patients and prior retrospective studies often lacked long-term follow-up on overall survival (OS). This has limited our knowledge about the influence of HIV status on survival in BL and DLBCL. Survival outcomes can also vary significantly across ethnic groups, influenced mostly by disparities in healthcare access and socioeconomic status. Additionally, survival rates differ among age groups, which may be attributed to tolerance to intensive chemotherapy and the presence of comorbid medical conditions. Our study primarily focused on comparing OS between HIV-positive and negative patients with DLBCL and BL in the real world. We also examined OS disparities among diverse ethnicities and age groups. Method: Patients diagnosed with DLBCL and BL were identified from the Cerner Health Facts database over five years from 2013 to 2018 using ICD-9 and ICD-10 codes. Within this cohort, individuals with a positive HIV status were identified through specific ICD-9 and ICD-10 codes. Demographic characteristics including age, gender, and ethnicity were collected for all patients, and they were stratified into distinct age groups: &lt;20 years, 20-39 years, 40-59 years, 60-79 years, and 80+ years. OS was calculated for all patients from the time of diagnosis to time of death or hospice discharge. A multivariate cox regression model was employed to adjust for confounding variables. Results: The total number of patients diagnosed with DLBCL and BL was 10,534. Of these patients, 45.3% were female. The ethnic composition included 77% Caucasian, 10.3% African American and 12.7 % from other ethnicities. Among this population, 315 patients were HIV positive. In the cohort of DLBCL patients, 8,275 were HIV negative and 185 were HIV positive. In the cohort of BL patients, 1,944 were HIV negative and 130 were HIV positive. Among patients with DLBCL, HIV positive status had more than two-fold higher mortality rate compared to their HIV negative counterparts (HR=2.1, 95% CI 1.31 to 3.36, p=0.0018). Patients with BL who were HIV positive had no difference in OS in comparison to the HIV negative group (p=0.575). African American patients with DLBCL had almost 40% increased risk of mortality compared to Caucasian patients (HR=1.39, 95% CI 1.05-1.83, p=0.017). African American patients with BL had no difference in OS compared to Caucasian patients (p=0.3). Patients aged 60-79 years were found to have 44% higher risk of mortality compared to 40-59 age group (HR=1.44, 95% CI 1.13-1.83, p=0.0033) and patients aged 80 years or above were found to have more than two-fold higher risk of mortality in the DLBCL cohort (HR=2.16, 95% CI 1.63-2.87, p&lt;0.0001). For patients with BL, those aged 20-39 had half the risk of mortality as compared to the 40-59 age group (HR= 0.50, 95% CI 0.28 - 0.87, p=0.014) whereas patients aged 80 or older had almost three times higher risk of mortality (HR = 2.87, 95% CI 1.81-4.57, p&lt;0.0001). Conclusion: HIV status can significantly influence survival outcomes in patients diagnosed with DLBCL. Early identification of HIV infection, along with the initiation of prompt antiretroviral therapy and the administration of appropriate intensive chemotherapy regimens, is crucial for optimizing treatment outcomes in this patient population. Notably, our study indicates that African American patients exhibit a higher mortality rate compared to their Caucasian counterparts with DLBCL. This could be related to disparities in access to healthcare and treatment resources across different ethnicities. Moreover, it also indicates possible lymphoma biological heterogeneity in various ethnicities. Furthermore, elderly patients demonstrate increased mortality rates likely attributed to a greater prevalence of frailty, indicating the need for innovative less intense regimens for these patients with DLBCL and BL.