Adjusted delivery, stronger outcomes: Selinexor therapeutic adaptation and positioning in previously treated multiple...

In patients with lenalidomide-refractory multiple myeloma from the BOSTON trial subgroup analysis,¹ selinexor (SEL) dose reduction versus full dosing substantially improved efficacy outcomes, including higher overall response rate (74.3% vs. 55.6%), deeper responses (≥ very good partial response: 48.6% vs. 11.1%), longer duration of response (15.3 vs. 4.2 months), longer time to next treatment (14.8 vs. 4.8 months) and longer progression-free survival (13.9 months vs. 5.1 months). Selinexor dose reduction further improved tolerability, enabling longer treatment duration, with non-haematological adverse events such as nausea, fatigue, diarrhoea, decreased appetite and vomiting all decreased meaningfully after the first SEL dose reduction. Quality of life improved meaningfully also: global health status quality assessed via European Organization for Research and Treatment of Cancer Quality of Life Questionnaire improved more than twice as much in the SEL-reduced group versus the full-dose group, with the dose-reduced patients exceeding the clinically meaningful 10-point improvement threshold after dose reduction. Commentary on: Delimpasi et al. Benefit of selinexor dose reduction on outcomes with selinexor, bortezomib and dexamethasone in patients with lenalidomide-refractory multiple myeloma: Subgroup analysis of the BOSTON trial. Br J Haematol 2026 (Online ahead of print). doi: 10.1111/bjh.70479.