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.

Authors

Matthew J Rees, Masa Lasica, Anna Kalff, Michael Low, Rosemary Harrup, Hock Choong Lai, M Hasib Sidiqi, Nicole Wong Doo, David Routledge, Jay Hocking, Philip Campbell, Jessica Heenan, Noemi Horvath, Nicole Chien, William E P Renwick, Georgia McCaughan, Richard Eek, Douglas S Lenton, Tricia Wright, Sher Gul Gazdar, Deepmala Mazumdar, Belinda Butcher, Peter Mollee, Hang Quach, Australasian Leukaemia and Lymphoma Group

Published in

British journal of haematology. Sep 22, 2026. Epub Sep 22, 2026.

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.

PMID:
42770812
Bibliographic data and abstract were imported from PubMed on 22 Sep 2026.

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