Background: MM is a cancer of the immune system. Infections are common reasons for hospitalization and death in MM. As MM patients (pts) are living longer, with prolonged exposure to systemic therapy, there is a need to vaccinate pts and to determine the effectiveness of these vaccines. Vaccination in MM pts is underutilized, based on a study of vaccination patterns in a large health system (Alemu JPCRR 2017) and data collected via a pt self-report online portal (Thompson ASCO 2020). We analyzed FV and PV patterns and associated outcomes in INSIGHT MM, the largest global, prospective, observational study in MM to date. Methods: INSIGHT MM aims to understand MM pt and disease characteristics at diagnosis and relapse, treatment patterns, clinical outcomes, and treatment-associated tolerability, effectiveness, quality of life, and healthcare resource utilization. INSIGHT MM has enrolled 4318 MM pts from 15 countries worldwide; pts are being followed up prospectively for ≥5 yrs. Vaccine status is collected at study entry and yearly. We analyzed FV and PV patterns and associated outcomes of pts enrolled in July 2016–2019. Results: At data cutoff (Sep 1, 2019), 2562/2523 pts had study entry data on FV/PV status. Overall vaccination rates were low (FV 40%, PV 30%) and varied by region: FV 56%/38%/27%/4% and PV 43%/28%/21%/5% in US/Europe/Latin America/Asia. In evaluable pts, lack of vaccination was associated with higher infection and hospitalization rates for FV, and with increased risk of death (univariate analysis) for both FV and PV (Table; multivariate analysis underway). Infections, including influenza and pneumonia, were the cause of death in 19% (43/226) / 8% (9/108) (P = 0.018) of pts who did not receive FV / received it in the past 2 yrs and 19% (46/236) / 9% (9/100) (P = 0.027) of pts who did not receive PV / received it in the past 5 yrs, and in 7%/15%/20%/40% of pts who died in US/ Europe/Latin America/Asia (P < 0.0001). Conclusions: Global vaccination rates in MM pts were low and varied by region. Lack of vaccination correlated with rates of infection (FV), hospitalization (FV), and death (FV and PV). Further MM datasets should be analyzed to confirm the findings. Vaccination data should be collected in prospective clinical trials as it may affect survival. Vaccination is important in MM and should be encouraged. Clinical trial information: NCT02761187.