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CASE REPORT article

Front. Oncol.
Sec. Hematologic Malignancies
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1477697

Selinexor in combination with venetoclax and decitabine in patients with refractory myelodysplastic syndrome previously exposed to hypomethylating agents: three case reports

Provisionally accepted
Yunshuo Xiao Yunshuo Xiao 1*Kun Yang Kun Yang 2,3Qiuying Huang Qiuying Huang 1*Changqing Wei Changqing Wei 1*Manlv Wei Manlv Wei 1*Zhili Geng Zhili Geng 1*Hui Wu Hui Wu 1*Tianhong Zhou Tianhong Zhou 1*Yali Zhou Yali Zhou 1*
  • 1 The 923 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Nanning, Guangxi Zhuang Region, China
  • 2 Zigong First People's Hospital, Zigong, China
  • 3 West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

The final, formatted version of the article will be published soon.

    The management of patients with myelodysplastic syndrome (MDS) refractory to hypomethylating agents (HMAs) remains a challenge with few reliably effective treatments. Preclinical studies have shown that the inhibition of the nuclear export protein XPO1 causes nuclear accumulation of p53 and disruption of NF-κB signaling; both of which are relevant targets for MDS. Selinexor is an XPO1 inhibitor with demonstrated efficacy in MDS patients. Herein, we report three patients with MDS refractory to HMAs, however, when selinexor and venetoclax were added to the treatment regimen, the patients achieved a complete response and a significant reduction in spleen size. All patients successfully underwent hematopoietic stem cell transplantation. These cases demonstrate that the combination therapy can achieve CR and significant reductions in spleen size, offering a promising therapeutic option for patients with limited treatment choices. Combination therapy would also offer a potential way for patients to bridge to transplantation. Formal evaluations of this regimen in patients with MDS refractory to HMAs may be meaningful.

    Keywords: Selinexor, venetoclax, Hypomethylating agents, myelodysplastic syndrome, Acute Myeloid Leukemia

    Received: 08 Aug 2024; Accepted: 02 Dec 2024.

    Copyright: © 2024 Xiao, Yang, Huang, Wei, Wei, Geng, Wu, Zhou and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Yunshuo Xiao, The 923 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Nanning, 530021, Guangxi Zhuang Region, China
    Qiuying Huang, The 923 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Nanning, 530021, Guangxi Zhuang Region, China
    Changqing Wei, The 923 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Nanning, 530021, Guangxi Zhuang Region, China
    Manlv Wei, The 923 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Nanning, 530021, Guangxi Zhuang Region, China
    Zhili Geng, The 923 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Nanning, 530021, Guangxi Zhuang Region, China
    Hui Wu, The 923 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Nanning, 530021, Guangxi Zhuang Region, China
    Tianhong Zhou, The 923 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Nanning, 530021, Guangxi Zhuang Region, China
    Yali Zhou, The 923 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Nanning, 530021, Guangxi Zhuang Region, China

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