Patients across the RRMM treatment landscape need different drug classes1-3

hero bg detail - dots

Patients who are progressing on an anti-CD38 mAb-based regimen, unlikely candidates for CAR-T or BsAbs, awaiting CAR-T or BsAbs, or progressing on CAR-T or BsAbs, may need different drug classes.1-24

In MAMMOTH (N=275), a retrospective study, outcomes once a patient became refractory3*:

31%

ORR

3.4

MONTHS mPFS

9.3

MONTHS mOS

In a prospective phase 2b study (N=32), outcomes when an anti-CD38 mAb was immediately recycled4†:

0%

ORR

1.6

MONTHS mPFS

10.7

MONTHS mOS

*Data collected between January 2017 and June 2018. The subgroup of 249 patients who received ≥1 subsequent treatment beyond T0 was analyzed using comparisons of PFS and OS estimates. T0 was the time point when patients met the criteria of progression as defined by the IMWG Response Criteria.

†Based on a prospective analysis of 32 patients refractory to an anti-CD38 mAb recycled with an anti-CD38 mAb-based regimen in their next line of therapy.

Clinical icon

CLINICAL:

poor performance status, poorly controlled disease, major organ dysfunction5-11‡

Nonclinical icon

NONCLINICAL:

unable to travel to facility, lack of a caregiver, financial clearance, and affordability concerns (including travel and accomodations)11-17

‡Based on the protocols for the phase 3 trials of 2 FDA-approved CAR-T therapies and 3 FDA-approved BsAb therapies.

  • Logistics
  • Financial clearance
  • Manufacturing availability
  • Apheresis capacity
  • Disease progression
IMWG recommends icon

The IMWG recommends physicians “strongly consider” a line of therapy after CAR-T apheresis9
For patients who have high disease burden or who are at risk of morbidity during the 4- to 6-week manufacturing process.

t-cell icon

T-cell exhaustion can drive early relapse and limit subsequent CAR-T or BsAb therapy25,26

33% icon

In a prospective phase 2 study (n=187), BCMA-exposed patients who were treated with a BCMA-targeted BsAb had an ORR of 33% compared to 58% for those who were BCMA-naive27§

IMWG icon

IMWG recommends utilizing a different mechanism of action or different target for patients progressing after receiving a BCMA-targeting BsAb15

NCCN disclaimer icon

The National Comprehensive Cancer Network® (NCCN®) recommends introducing different drugs/drug classes28

For RRMM, the NCCN recommends new regimens, including drugs or drug classes that patients have not been exposed to before or for at least 6 months.

NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

Next steps

Chevron icon with pink circule bg

Patient Profiles

See why XPOVIO + Vd may be appropriate for your patient at various points in the RRMM treatment journey.

Chevron icon with pink circule bg

Request a Rep

Ask questions and learn more about treating RRMM with XPOVIO.

Abbreviations: BsAb, bispecific antibody; CAR-T, chimeric antigen receptor T-cell therapy; IMWG, International Myeloma Working Group; mAb, monoclonal antibody; mOS, median overall survival; mPFS, median progression-free survival; ORR, overall response rate; OS, overall survival; PFS, progression-free survival; RRMM, relapsed or refractory multiple myeloma; T0, time zero; Vd, bortezomib and dexamethasone.

NCCN, National Comprehensive Cancer Network®.

References: 1. Mateos M-V, Weisel K, De Stefano V, et al. Leukemia. 2022;36(5):1371-1376. doi:10.1038/s41375-022-01531-2 2. Lesokhin AM, Tomasson MH, Arnulf B, et al. Nat Med. 2023;29(9):2259-2267. doi:10.1038/s41591-023-02528-9 3. Gandhi UH, Cornell RF, Lakshman A, et al. Leukemia. 2019;33(9):2266-2275. doi:10.1038/s41375-019-0435-7 4. Mikhael J, Belhadj-Merzoug K, Hulin C, et al. Blood Cancer J. 2021;11(5):89. doi:10.1038/s41408-021-00478-4 5. San-Miguel J, Dhakal B, Yong K, et al. N Engl J Med. 2023;389(Protocol JNJ- 68284528-MMY-3002):335-347. doi:10.1056/NEJMoa2303379 6. Rodriguez-Otero P, Ailawadhi S, Arnulf B, et al. N Engl J Med. 2023;388(11)(Protocol BB2121-MM-003):1002-1014. doi:10.1056/NEJMoa2213614 7. Tecvayli. Prescribing information. Janssen Biotech, Inc; 2025. 8. Talvey. Prescribing information. Janssen Biotech, Inc; 2025. 9. Lynozyfic. Prescribing information. Regeneron Pharmaceuticals, Inc; 2025. 10. Derman B, Tan C, Steinfield I, et al. Cancers. 2025;17(7):1235. doi:10.3390/cancers17071235 11. Riedell PA, Downs C, Boehmer L, Ebmeier J, Porter D, Williams A. Transplant Cell Ther. 2024;30(1):14-16. doi:10.1016/j.jtct.2023.10.019 12. Carvykti. Prescribing information. Janssen Biotech, Inc; 2024. 13. Abecma. Prescribing information. Bristol-Myers Squibb; 2021. 14. Barata A, Hoogland AI, Hyland KA, et al. Psychooncology. 2021;30(8):1294-1301. doi:10.1002/pon.5674 15. Costa LJ, Banerjee R, Mian H, et al. Leukemia. 2025;39(3):543-554. doi:10.1038/s41375-024-02482-6 16. CAR-T cell therapy: a guide for adult patients and caregivers. Memorial Sloan Kettering Cancer Center. Updated July 11, 2025. Accessed February 25, 2026. https://www.mskcc.org/cancer-care/patient-education/car-cell-therapy-guide-adult-patients-caregivers 17. CAR-T cell therapy. Dana-Farber Cancer Institute. Accessed February 25, 2026. https://cartpatient.dana-farber.org/identifying-a-caregiver.html 18. Holstein SA, Grant SJ, Wildes TM. J Clin Oncol. 2023;41(27):4416-4429. doi:10.1200/JCO.23.00512 19. Garfall AL, Banerjee R, Frenzel L, et al. Front Oncol. 2025;15:1630146. doi:10.3389/fonc.2025.1630146. 20. Tan MSY, Hellou T, Dingli D. Discov Oncol. 2025;16(1):1573. doi:10.1007/s12672-025-03432-z 21. Mohan M, Van Oekelen O, Akhtar OS, Cohen A, Parekh S. Am Soc Clin Oncol Educ Book. 2024;44(3):e432204. doi:10.1200/EDBK_432204 22. Ahn S, Leblay N, Neri P. Hemasphere. 2021;5(6):e575. doi:10.1097/HS9.0000000000000575 23. Tedder B, Bhutani M. Cells. 2025;14(14):1077. doi:10.3390/cells14141077 24. Zhang X, Zhang H, Lan H, Wu J, Xiao Y. Front Immunol. 2023;14:1101495. doi:10.3389/fimmu.2023.1101495 25. van de Donk NWCJ, Rasche L, Sidana S, Zweegman S, Garfall AL. Blood Cancer Discov. 2024;5(6):388-399. doi:10.1158/2643-3230.BCD-24-0124 26. Ledergor G, Fan Z, Wu K, et al. Blood Adv. 2024;8(13):3562-3575. doi:10.1182/bloodadvances.2023012416 27. Elrexfio. Prescribing Information. Pfizer Inc; 2023. 28. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Multiple Myeloma V5.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed January 20, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org.

+

INDICATION

XPOVIO® (selinexor) is a prescription medicine approved in combination with bortezomib and dexamethasone (XVd) to treat adult patients with multiple myeloma who have received at least one prior therapy.

IMPORTANT SAFETY INFORMATION

Thrombocytopenia: XPOVIO can cause life-threatening thrombocytopenia, potentially leading to hemorrhage. Thrombocytopenia was reported in patients with multiple myeloma.

Thrombocytopenia is the leading cause of dosage modifications. Monitor platelet counts at baseline and throughout treatment. Monitor more frequently during the first 3 months of treatment. Monitor patients for signs and symptoms of bleeding. Interrupt, reduce dose, or permanently discontinue based on severity of adverse reaction.

Neutropenia: XPOVIO can cause life-threatening neutropenia, potentially increasing the risk of infection.

Monitor more frequently during the first 3 months of treatment. Consider supportive measures, including antimicrobials and growth factors (e.g., G-CSF). Interrupt, reduce dose, or permanently discontinue based on severity of adverse reaction.

Gastrointestinal Toxicity: XPOVIO can cause severe gastrointestinal toxicities in patients.

Nausea/Vomiting/Diarrhea: Provide prophylactic antiemetics or treatment as needed.

Anorexia/Weight Loss: Monitor weight, nutritional status, and volume status at baseline and throughout treatment and provide nutritional support, fluids, and electrolyte repletion as clinically indicated.

Hyponatremia: XPOVIO can cause severe or life-threatening hyponatremia.

Monitor sodium level at baseline and throughout treatment.

Serious Infection: XPOVIO can cause serious and fatal infections. Atypical infections reported after taking XPOVIO include, but are not limited to, fungal pneumonia and herpesvirus infection.

Neurological Toxicity: XPOVIO can cause life-threatening neurological toxicities.

Coadministration of XPOVIO with other products that cause dizziness or mental status changes may increase the risk of neurological toxicity.

Advise patients to refrain from driving and engaging in hazardous occupations or activities, until the neurological toxicity fully resolves. Institute fall precautions as appropriate.

Embryo-Fetal Toxicity: XPOVIO can cause fetal harm when administered to a pregnant woman.

Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential and males with a female partner of reproductive potential to use effective contraception during treatment with XPOVIO and for 1 week after the last dose.

Cataracts: New onset or exacerbation of cataract has occurred during treatment with XPOVIO. The incidence of new onset or worsening cataract requiring clinical intervention was reported.

ADVERSE REACTIONS

The most common adverse reactions (ARs) (≥20%) in patients with multiple myeloma who received XVd were fatigue, nausea, decreased appetite, diarrhea, peripheral neuropathy, upper respiratory tract infection, decreased weight, cataract, and vomiting.

Grade 3-4 laboratory abnormalities (≥10%) were thrombocytopenia, lymphopenia, hypophosphatemia, anemia, hyponatremia and neutropenia.

Fatal ARs occurred in 6% of patients within 30 days of last treatment. Serious ARs occurred in 52% of patients. Treatment discontinuation rate due to ARs was 19%. The most frequent ARs requiring permanent discontinuation in >2% of patients included fatigue, nausea, thrombocytopenia, decreased appetite, peripheral neuropathy and vomiting. Adverse reactions led to XPOVIO dose interruption in 83% of patients and dose reduction in 64% of patients.

USE IN SPECIFIC POPULATIONS

No overall difference in effectiveness of XPOVIO was observed in patients >65 years old when compared with younger patients. Patients ≥65 years old had a higher incidence of discontinuation due to an adverse reaction (AR) and a higher incidence of serious ARs than younger patients.

The effect of end-stage renal disease (CLCR <15 mL/min) or hemodialysis on XPOVIO pharmacokinetics is unknown.

Please see full Prescribing Information.

To report SUSPECTED ADVERSE REACTIONS, contact Karyopharm Therapeutics Inc. at 1-888-209-9326 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

© 2026 Karyopharm Therapeutics Inc.

X