Selinexor-based non-intensive chemotherapy regimens adjusted according to early responses achieve high early remission in newly diagnosed AML or MDS

作者：Shiyuan Zhang, Shuai Su, Bin Xu, Xiwen Tong, Yi Zhun Zhu, Andie Fu, Zhuoxin Wen, Zhiqiong Wang, Jia Wei, Donghua Zhang · 发表于：Blood · 年份：2025 · DOI：10.1182/blood-2025-1673 · 研究领域：Acute Myeloid Leukemia Research、Retinoids in leukemia and cellular processes、Nuclear Structure and Function

Abstract Background Some newly diagnosed (ND) acute myeloid leukemia (AML) or higher-risk myelodysplastic syndrome (MDS) patients (pts) are ineligible for or unwilling to receive intensive chemotherapy. These pts usually receive low-intensity regimens. preliminary data from clinical trials have indicated that non-intensive chemotherapy containing selinexor can achieve a relatively high response rate in unfit AML. Therefore, we explored selinexor-based chemotherapy-free or low-dose chemotherapy regimens in the above-mentioned ND AML or MDS. Aims To investigate the efficacy and safety of selinexor based non-intensive chemotherapy for the ND AML or MDS, and evaluate the timing for early adjustment of the regimens. Methods Pts who refused or were ineligible for intensive chemotherapy were enrolled and received the following regimens: selinexor was initially dosed at 35 mg/m2 twice a week (60mg BIW). Azacitidine 75 mg/m2/d for 5 to 7 days, venetoclax was administered at 100 mg, 200 mg, and 400 mg on d1-3, respectively, followed by 400 mg daily days 3 to 14 (XAB regimen). Bone marrow puncture was performed every week during the treatment. According to whether CR/CRi was achieved in the first and second weeks, subsequent treatments were adjusted according to the response. Pts who achieved CR/CRi early subsequently received allo-HSCT if they were fit for or willing to undergo transplantation. Other pts were treated with low-dose cytarabine (Ara-C) 50mg/d on the basis of XAB regimen f...