NSP-11: Haematology Society of Australia & New Zealand Myeloma Specialists Practice Network (MSPN) Consensus recommendations on supportive care for patients with multiple myeloma receiving selinexor

Introduction: Selinexor is a first in class, oral, selective inhibitor of nuclear export (SINE) that is approved for the treatment of relapsed refractory multiple myeloma (RRMM). Selinexor has a significantly different toxicity profile to other MM treatments yet has not been included in current supportive care guidelines. Patients receiving selinexor may be heavily pre-treated, with significant disease and treatment related morbidities, and have comorbidities of an older patient group. Early recognition and implementation of supportive care interventions is critical to minimise selinexor-related toxicities and reduce risk of subsequent discontinuation of therapy.


Aim: To provide guidance for nurses to deliver best supportive care to those receiving selinexor through development of living consensus recommendations.

Methods: The approach to developing consensus recommendations when there is limited research evidence was followed. A Selinexor Expert Advisory Group (SEAG) was established, all available published research, including selinexor licensing clinical trial data and papers focused on dosing, toxicity and management were examined. In addition, optimal supportive care, national and international guidelines associated with cancer supportive care were identified and reviewed. Draft consensus recommendations were developed, and a formal consensus process followed with SEAG. Draft recommendations were reviewed by an international MM nurse leader with experience in managing selinexor toxicities, a haematologist, and an academic nurse researcher prior to presentation to the M-SPN membership. Feedback from members was minor and incorporated into the final document.

Results: Consensus

Recommendations: Three core areas: 1. Patient and carer education prior to commencing treatment focusing on different symptom profile, importance of recognising and early reporting of symptoms, adherence to medications to reduce toxicities, concurrent supportive medications in an often medically fragile population. 2. Prompt and proactive symptom management in the first few cycles of therapy can reduce the risk of treatment discontinuation due to toxicity. 3. Prompt dose reduction in presence of therapy-related adverse events (TRAEs) with a ‘go slow and low’ approach can further help patients better adjust to therapy. The recommendations include brief information about selinexor indication, dosing/reductions, TRAE incidence and management of common toxicities, treatment checklist, links to 3rd party consumer information and patient treatment calendars, previously developed by our group https://rego.interact.technology/myetx/.

Conclusions: Such level IV evidence that provides grade C recommendations provides useful evidence where data is lacking. This consensus guideline is important particularly as selinexor is reimbursed for the treatment of RRMM in Australia and will be updated regularly.
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