[Deep and durable response with the selinexor-bortezomib-dexamethasone combination in a patient with multiple myeloma refractory to first-line treatment.]

The management of relapsed or refractory multiple myeloma in elderly patients remains challenging, particularly in cases of early refractoriness to first-line anti-CD38-based regimens, which is associated with poor prognosis and limited therapeutic options. We report the case of a 75-year-old woman with IgG kappa multiple myeloma, primarily refractory to first-line daratumumab, lenalidomide and dexamethasone, who was treated with second-line selinexor, bortezomib and dexamethasone. The patient achieved a very good partial response after four cycles and a complete response after ten cycles, which was durable over time. Treatment was well tolerated, allowing full-dose selinexor administration and preserving quality of life. This case supports the role of an early therapeutic class switch and highlights the effectiveness and feasibility of selinexor-based regimens in elderly and frail patients.