Selinexor plus lenalidomide versus lenalidomide alone as maintenance therapy after autologous haematopoietic stem cell transplantation in newly diagnosed multiple myeloma: Results of the phase 3 ALLG MM23 (SeaLAND) trial
- Author(s)
- Rees, MJ; Lasica, M; Kalff, A; Low, M; Harrup, R; Lai, HC; Sidiqi, MH; Doo, NW; Routledge, D; Hocking, J; Campbell, P; Heenan, J; Horvath, N; Chien, N; Renwick, WEP; McCaughan, G; Eek, R; Lenton, DS; Wright, T; Gazdar, SG; Mazumdar, D; Butcher, B; Mollee, P; Quach, H; Australasian Leukaemia and Lymphoma Group;
- Journal Title
- British Journal of Haematology
- Publication Type
- Online publication before print
- Abstract
- SeaLAND (ALLG MM23, ACTRN12620000291987) was a randomized, open-label phase III study evaluating low-dose weekly selinexor (40 mg) plus lenalidomide (selinexor-R) versus lenalidomide alone (R) as post-transplant maintenance therapy for newly diagnosed, transplant-eligible multiple myeloma. A total of 142 patients were enrolled (R = 64; selinexor-R = 78); the trial closed early for futility. At best response, the complete response (≥CR) rate was numerically, but not significantly, higher with selinexor-R than R (67% vs. 53%, p = 0.09). At 24 months median follow-up, progression-free survival (PFS) was not significantly different between selinexor-R compared to R (hazard ratio [HR] = 1.22; 95% confidence interval [CI] 0.62-2.41; p = 0.56); 24-month PFS rates were 73% (95% CI 57%-84%) for R and 70% (95% CI: 56%-81%) for selinexor-R. The mean relative dose intensity (RDI) of R was lower in the selinexor-R arm compared to R alone (68% vs. 81%, p = 0.002); the mean RDI of S was 55%. Grade ≥3 adverse events were more frequent with selinexor-R (85% vs. 45%, p < 0.001). Common severe non-haematological adverse events included infections (R: 6%, selinexor-R: 19%, p < 0.01) and gastrointestinal disorders (R: 3%, selinexor-R: 14%, p < 0.05). Selinexor-R maintenance did not improve PFS and substantially increased toxicity. Selinexor-R maintenance cannot be recommended for the general myeloma population; we did not observe a benefit among high-risk disease.
- Keywords
- autologous haematopoietic stem cell transplantation; maintenance; multiple myeloma; newly diagnosed multiple myeloma; selinexor
- Department(s)
- Haematology
- Publisher's Version
- https://doi.org/10.1111/bjh.70851
- Open Access at Publisher's Site
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Creation Date: 2026-10-12 05:40:50
Last Modified: 2026-10-12 05:41:16