{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:27:33Z","timestamp":1786976853895,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Patients with relapsed\/refractory multiple myeloma (RRMM) who are penta\u2010drug refractory, defined as resistant to two proteasome inhibitors, two immunomodulatory agents, and an anti\u2010CD38 monoclonal antibody, face a dismal prognosis, particularly after exposure to T\u2010cell\u2013redirecting therapies. Selinexor, an oral exportin\u20101 inhibitor, offers a distinct mechanism of action and may retain efficacy in this difficult setting. We conducted a retrospective analysis at six German tertiary centers (2023\u20132025) to evaluate the efficacy and safety of selinexor plus bortezomib and dexamethasone (SVd) in penta\u2010refractory MM after both BCMA\u2010 and GPRC5D\u2010targeted therapies. Eighteen patients were identified, with a median of seven prior lines of therapy. High\u2010risk cytogenetic abnormalities were present in seven cases, including del17p in six. The overall response rate (ORR) was 61%, including one complete, five very good partial, and five partial responses, and median progression\u2010free survival (PFS) was 4.3\u2009months. Among nine patients (50%) with extramedullary disease (EMD), three achieved complete and one near\u2010complete EMD resolution. Two patients who had relapsed after CAR T\u2010cell treatment with idecabtagene vicleucel achieved partial and very good partial responses and were successfully transitioned to a second CAR T\u2010cell therapy with ciltacabtagene autoleucel. Hematologic toxicities under SVd were manageable, and no treatment\u2010related deaths occurred. SVd demonstrates meaningful activity in patients with penta\u2010refractory MM and prior failure of BCMA\/GPRC5D\u2010targeted immunotherapies. The ORR of 61%, disease control in 78% of patients, and median PFS of 4.3\u2009months support further evaluation of SVd in this highly refractory setting after failure of BCMA\u2010 and GPRC5D\u2010directed approaches.<\/jats:p>","DOI":"10.1002\/ajh.70297","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T10:37:32Z","timestamp":1774953452000},"page":"1433-1439","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Navigating the Post\u2010\n                    <scp>BCMA<\/scp>\n                    \/\n                    <scp>GPRC5D<\/scp>\n                    Landscape: Efficacy of Selinexor, Bortezomib, and Dexamethasone After Sequential Immunotherapy Failure in Penta\u2010Refractory Multiple Myeloma\u2014A Multicenter Analysis"],"prefix":"10.1002","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8081-7091","authenticated-orcid":false,"given":"Maximilian","family":"Al\u2010Bazaz","sequence":"first","affiliation":[{"name":"Department of Oncology, Hematology and Bone Marrow Transplantation With Division of Pneumology University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winfried","family":"Alsdorf","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology and Bone Marrow Transplantation With Division of Pneumology University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Leypoldt","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology and Bone Marrow Transplantation With Division of Pneumology University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piet","family":"Sonnemann","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology and Bone Marrow Transplantation With Division of Pneumology University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6494-5105","authenticated-orcid":false,"given":"Christoph","family":"Schaefers","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology and Bone Marrow Transplantation With Division of Pneumology University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jule","family":"Artzenroth","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology and Bone Marrow Transplantation With Division of Pneumology University Medical Center Hamburg\u2010Eppendorf  Hamburg 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Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon","family":"Cords","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology and Bone Marrow Transplantation With Division of Pneumology University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Vorwerk","sequence":"additional","affiliation":[{"name":"Department of Hematology, Oncology, University Medical Center Schleswig\u2010Holstein, Campus L\u00fcbeck University Cancer Center\u2010Schleswig\u2010Holstein, University of L\u00fcbeck  L\u00fcbeck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo","family":"Leitner","sequence":"additional","affiliation":[{"name":"Department of Hematology, Oncology, University Medical Center Schleswig\u2010Holstein, Campus L\u00fcbeck University Cancer Center\u2010Schleswig\u2010Holstein, University of L\u00fcbeck  L\u00fcbeck 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of Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udo","family":"Holtick","sequence":"additional","affiliation":[{"name":"Department I of Internal Medicine, University Hospital of Cologne University of Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan M.","family":"Hillmann","sequence":"additional","affiliation":[{"name":"Asklepios Tumorzentrum Hamburg Asklepios Klinik Altona  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Salwender","sequence":"additional","affiliation":[{"name":"Asklepios Tumorzentrum Hamburg Asklepios Klinik Altona  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus","family":"Khandanpour","sequence":"additional","affiliation":[{"name":"Department of Hematology, Oncology, University Medical Center Schleswig\u2010Holstein, Campus L\u00fcbeck University Cancer 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