Background: Novel treatments (tx) and advancements in autologous stem cell transplant (ASCT) have improved overall survival (OS) for patients (pts) with MM. The present study aimed to assess tx patterns, healthcare costs, and OS for Caucasians (CAU) and African Americans (AA) with MM. Methods: CAU and AA with MM in the SEER-Medicare database (2007-2011) were included. The index date was defined as the first MM diagnosis (dx) date. Pts were required to be continuously enrolled in Medicare Part A, B, and D for 6 months (mos) before (baseline period) and ≥ 6 mos after the index date (study period) unless they died. Tx, costs, and OS were assessed during the study period. Proportions of pts receiving specific MM tx were compared between cohorts using Chi square tests. Time-to-therapy initiation and OS were described using Kaplan Meier analyses and compared using log-rank tests. Costs were compared using Wilcoxon rank sum tests. Results: The study included2,200 CAU and 536 AA. The CAU cohort had a higher proportion of men (51% vs 42%, p < 0.01), were older (mean age 76 vs 73), and married (52% vs 25%, p < 0.01) as compared to AA. AA had lower rates of ASCT (3% vs 6%, p < 0.01) and novel (lenalidomide, thalidomide, or bortezomib) combination therapies (66% vs 74% among pts with pharmacological therapy, p < 0.01) compared to CAU, although the proportions with novel monotherapy was comparable (28% vs 25%). The median times from dx to therapy initiation (2.3 vs 1.7 mos, p < 0.05) and novel therapy initiation (5.3 vs 3.1 mos, p < 0.05) were significantly longer for AA than CAU. OS was comparable between AA and CAU (26.7 vs 30.0 mos, p = 0.27). AA incurred significantly higher monthly all-cause medical costs compared to CAU (mean: $10,395 vs $9,212, p < 0.05), but comparable drug costs ($1,855 vs $2,071) and total (medical + drug + other) costs ($12,250 vs $11,283). Conclusions: AA received less ASCT and novel combination therapies, and at a later time than CAU; however, OS and total healthcare costs were similar across cohorts, although AA had higher hospitalization costs. Differences in disease aggressiveness and other clinical characteristics at baseline between AA and CAU can affect tx outcomes and should be explored in future studies.