Efficacy analysis and adverse event management of selinexor in the treatment of relapsed/refractory multiple myeloma

The treatment of relapsed/refractory multiple myeloma (RRMM) remains a significant clinical challenge, particularly for patients with multidrug resistance, who have a poor prognosis and limited therapeutic options. Selinexor, as the world's first oral selective inhibitor of nuclear export (SINE), targets the XPO1 protein, offering a novel treatment mechanism distinct from traditional agents for RRMM. This narrative review systematically synthesizes the mechanism of action of Selinexor and critically evaluates evidence from key clinical studies (such as the STORM and BOSTON trials). It focuses on discussing its clinical positioning across different scenarios and its combination strategies with commonly used regimens (e.g., SVd). It also addresses standardized, proactive management pathways for its characteristic adverse effects (e.g., thrombocytopenia, gastrointestinal reactions). These strategies are tailored to patient stratification (such as triple-/penta-refractory, elderly/frail patients). The aim is to provide clinicians with a practical, evidence-based reference for the safe and effective application of this drug to optimize treatment outcomes for RRMM patients.