Dr Bose on the Potential Role of Selinexor Plus Ruxolitinib in Myelofibrosis

If [the SENTRY combination] is approved, [selinexor plus ruxolitinib] would be our first ruxolitinib-based combination to be approved [and] the only one to have a survival benefit. We have not seen that with pelabresib or navitoclax.

Prithviraj Bose, MD, a professor and co-leader of the section of myeloproliferative neoplasms (MPNs) in the Department of Leukemia at The University of Texas MD Anderson Cancer Center, discussed data from the phase 3 SENTRY trial (NCT04562389) evaluating selinexor (Xpovio) plus ruxolitinib (Jakafi) in patients with JAK inhibitor–naive myelofibrosis. At the 2026 Society of Hematologic Oncology (SOHO) Annual Meeting, Bose also explained where the combination could fit into practice if approved by the FDA.

Selinexor is currently FDA-approved as part of combination therapies for the treatment of select patients with relapsed/refractory multiple myeloma, and Bose noted its safety has therefore already been established, meaning off-label use could be considered in appropriate patients ahead of a myelofibrosis-specific approval.

However, a myelofibrosis-specific approval could be around the corner after a supplemental new drug application was submitted to the FDA in August 2026, seeking accelerated approval of the combination for the treatment of patients with JAK inhibitor–naive myelofibrosis, based on data from SENTRY. If approved, Bose said the combination would be the first ruxolitinib-based regimen to reach approval with a demonstrated survival benefit.

Bose said he would initially consider the combination for patients with higher-risk disease, noting SENTRY showed no signal of excess leukemic transformation in either arm. He said the regimen may suit patients with a particularly large spleen needing a more potent spleen-reducing approach, potentially as a bridge to transplant, or those with higher-risk features for whom a synergistic combination could address disease biology better than monotherapy. Bose also pointed to variant allele frequency (VAF) reductions of at least 20% at week 24, seen in 32.0% of evaluable patients in the selinexor arm (n = 169) compared with 23.9% with placebo (n = 92). As comfort with the combination grows and safety and survival data mature, he said the regimen could eventually become a standard frontline approach, although likely not immediately. Bose said the combination, if approved, could ultimately be offered to any patient currently eligible for ruxolitinib per its label.