Molecular response patterns in relapsed/refractory AML patients treated with selinexor and chemotherapy

Relapse in patients with acute myeloid leukemia (AML) is common and is associated with a dismal prognosis. Treatment options are limited and the understanding of molecular response patterns is still challenging. We analyzed the clonal response patterns of 15 patients with relapsed/refractory AML treated with selinexor in a phase II trial (SAIL). DNA was analyzed at three time points and showed a decline of mutated alleles in FLT3, SF3B1, and TP53 under SAIL treatment. Overall survival (OS) was similar between patients with declining versus persisting clones. We show an interesting long-term course of a patient who relapsed after allogeneic stem cell transplantation (alloHCT) with SF3B1- and SRSF2-mutated AML and received selinexor as maintenance treatment for 4 years. Measurable residual disease (MRD) remained detectable for 2 weeks after donor lymphocyte infusion (DLI) in this patient and then remained negative under selinexor maintenance treatment. Selinexor was tolerated well and was stopped after 4 years of SAIL treatment. We present an exploratory study and identify subclonal patterns of patients treated with selinexor.

Automated summary

Relapse is common in AML patients and has a poor prognosis. Treatment options are limited and understanding the molecular response patterns is challenging. In this study, we analyzed the response patterns of relapsed/refractory AML patients treated with selinexor and identified subclonal patterns. One patient showed a long-term course of remission with selinexor maintenance treatment after relapse following alloHCT. This exploratory study provides insights into the effects of selinexor in AML patients.