Selinexor is an oral, small molecule inhibitor of the nuclear export protein exportin 1 with demonstrated activity in hematologic and solid malignancies. Side effects associated with selinexor include nausea, vomiting, fatigue, diarrhea, decreased appetite, weight loss, thrombocytopenia, neutropenia, and hyponatremia. We reviewed 437 patients with multiple myeloma treated with selinexor and assessed the kinetics of adverse events and impact of supportive care measures. Selinexor reduced both platelets and neutrophils over the first cycle of treatment and reached a nadir between 28 and 42 days. Platelet transfusions and thrombopoietin receptor agonists were effective at treating thrombocytopenia, and granulocyte colony stimulating factors were effective at resolving neutropenia. The onset of gastrointestinal side effects (nausea, vomiting, and diarrhea) was most common during the first 1–2 weeks of treatment. Nausea could be mitigated with 5-HT3 antagonists and either neurokinin 1 receptor antagonists, olanzapine, or cannbainoids. Loperamide and bismuth subsalicylate ameliorated diarrhea. The primary constitutional side effects of fatigue and decreased appetite could be managed with methylphenidate, megestrol, cannabinoids or olanzapine, respectively. Hyponatremia was highly responsive to sodium replacement. Selinexor has well-established adverse effects that mainly occur within the first 8 weeks of treatment, are reversible, and respond to supportive care.

Selinexor 是一种口服小分子核输出蛋白输出蛋白 1 抑制剂，在血液学和实体恶性肿瘤中具有活性。与 selinexor 相关的副作用包括恶心、呕吐、疲劳、腹泻、食欲下降、体重减轻、血小板减少、中性粒细胞减少和低钠血症。我们回顾了 437 名接受 selinexor 治疗的多发性骨髓瘤患者，并评估了不良事件的动力学和支持性护理措施的影响。 Selinexor 在第一个治疗周期中减少了血小板和中性粒细胞，并在 28 至 42 天之间达到最低点。血小板输注和血小板生成素受体激动剂可有效治疗血小板减少症，粒细胞集落刺激因子可有效解决中性粒细胞减少症。胃肠道副作用（恶心、呕吐和腹泻）在治疗的前 1-2 周内最常见。 5-HT3 拮抗剂和神经激肽 1 受体拮抗剂、奥氮平或大麻素可以缓解恶心。洛哌丁胺和碱式水杨酸铋可改善腹泻。疲劳和食欲下降等主要全身副作用可以分别用哌醋甲酯、甲地孕酮、大麻素或奥氮平来控制。低钠血症对钠替代反应高度敏感。 Selinexor 具有明确的不良反应，主要发生在治疗的前 8 周内，这些不良反应是可逆的，并且对支持治疗有反应。