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

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 .