Background: Translocation (4;14) is a known adverse prognostic factor in myeloma. However, utilization of proteasome inhibitors (PIs) in myeloma has abrogated the negative impact of t(4;14) in myeloma, and some investigators question whether t(4;14) still needs to be considered a high-risk marker. Here, we present a retrospective analysis of 142 patients with t(4;14) and describe disease characteristics, treatment patterns, and long-term outcomes. Methods: From January 2007 to August 2016, 42 patients with newly diagnosed myeloma and t(4;14) were identified. Demographics, clinical characteristics, and outcomes data for the patients were obtained from our institutional review board-approved myeloma database. Responses were evaluated per IMWG Uniform Response Criteria. Results: The median age of this cohort was 59.6 years (range 33-78). Notable patient characteristics include: W/AA/Asian 25.9%/23.6%/50%; ISS I/II/III 36.4%/22.9%/24.1%; R-ISS I/II/III 0%/27.8%/25.8%. Median lab values at diagnosis include: Hgb 10.4 g/dL, Hct 30.8%, Cr 1.01, and Ca 9.4, Frequency of concurrent cytogenetic abnormalities include del(17p): 19.7%; del(13): 44.4%, and +1q21: 46.5%. A majority of patients (86.7%) were induced with either triplet or quadruplet regimens, with 88% of these regimens including a proteasome inhibitor. 78.9% of patients underwent ASCT. Of those responses captured, 75.3% achieved ≥VGPR (sCR 4.8%, CR 30.5%, VGPR 40%, PR 20%). Post-transplant, 88% achieved ≥VGPR (sCR 35.1%, CR 30.9%, VGPR 22.3%), and 82% received maintenance therapy. The most common maintenance regimens included revlimid (34.8%), bortezomib (16.5%), and RVD (11.3%); one-third of patients received triplet maintenance regimens. With a median follow up of 99.5 months, the overall mPFS and mOS for this cohort of t(4;14) patients was 47.6 m (95% CI 32.3-62.8) and 108.5 months (95% CI 87.9-129.2). In patients with both t(4;14) and del(17p), the mPFS was 20.8 months and mOS was 89.6 months; for concurrent t(4;14) and +1q21, the mPFS was 32.0 months and 89.6 months. In patients that received maintenance therapy versus no maintenance, the mPFS and mOS was 54.9 months (95% CI 47.4-62.4) and 115.3 months (95% CI 96.3-134.3) versus 14.7 months (95% CI 13.1-16.3) and 34.3 months (95% CI 10.1-58.5), respectively. Conclusions: Overall, the prognosis of t(4;14) myeloma patients significantly improved compared to the pre-proteasome inhibitor era. In particular, maintenance therapies (predominantly PI- based) have made a clear survival impact (doubling of mPFS to 4.5 years and mOS to 9.5 years) compared to patients that did not receive maintenance therapy. However, presence of other concomitant cytogenetic abnormalities such as +1q21 and del(17p) continues to confer poorer outcomes, and innovative approaches are needed to obtain better outcomes for this subgroup of patients.