Xpovio (selinexor)
An approved treatment for Multiple Myeloma.
Drug facts
The same compound appears under different names depending on the context. Here is how to identify Selinexor wherever you encounter it, plus the key facts at a glance.
- Generic name
- Selinexor
- Brand name
- Xpovio
- Development code
- KPT-330
- International name
- Nexpovio (European Union)
- Drug class
- Nuclear export inhibitor (XPO1 inhibitor)
- Manufacturer
- Karyopharm Therapeutics
- How it's taken
- Tablet by mouth, once a week with bortezomib or twice a week with dexamethasone
Xpovio (selinexor) is an XPO1-blocking tablet used in combination for adults with previously treated multiple myeloma[1].
- The FDA first approved Xpovio on July 3, 2019, under accelerated approval, with dexamethasone for heavily pretreated myeloma[2][3].
- On December 18, 2020, the FDA approved Xpovio with bortezomib and dexamethasone after at least 1 prior therapy, which also confirmed the 2019 approval[3].
- In the BOSTON trial, median progression-free survival was 13.9 months with Xpovio added to bortezomib and dexamethasone, against 9.5 months without it[1].
- Xpovio has no boxed warning, and its main label warnings are low platelets, low white cells, nausea and weight loss, low sodium, infections, confusion or dizziness, and cataracts[1].
- Xpovio is not approved for newly diagnosed myeloma, and its separate lymphoma (DLBCL) approval was withdrawn in April 2026 at Karyopharm's request[1][4].
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Where Selinexor fits
Xpovio is approved only for myeloma that has already been treated, and always with dexamethasone[1]. With bortezomib and dexamethasone, it is used after at least 1 prior therapy[1]. With dexamethasone alone, it is used after at least 4 prior therapies when the myeloma is refractory to at least 2 proteasome inhibitors, at least 2 immunomodulatory drugs and an anti-CD38 antibody[1].
How Selinexor works
Healthy cells and cancer cells move proteins in and out of the nucleus, the compartment that holds DNA. A carrier protein called exportin 1 (XPO1) ships many of them out, including tumor suppressor proteins, which normally act as brakes on cell growth[1].
Xpovio blocks XPO1, according to the label's lab studies[1]:
In lab and animal models, Xpovio worked together with dexamethasone or bortezomib, including in myeloma resistant to proteasome inhibitors[1]. On its label, Xpovio is always given with dexamethasone, with or without bortezomib[1].
Side effects and safety
- Low platelets. Reported in 92% in BOSTON (grade 3 to 4 in 43%), the leading cause of dose changes; bleeding occurred in 16% of people with low platelets.
- Low neutrophils. Reported in 48% in BOSTON (grade 3 to 4 in 12%); growth factors such as G-CSF may be used.
- Stomach and gut effects. Nausea 50%, vomiting 21%, diarrhea 32%, poor appetite 35% and weight loss 26% in BOSTON; anti-nausea medicine is given before and during treatment.
- Low blood sodium. Reported in 58% in BOSTON (grade 3 to 4 in 14%), with a median onset of 21 days.
- Serious infections. Grade 3 or higher infections in 32% in BOSTON, most often pneumonia; deaths from infection in 3.1%.
- Neurological effects. Dizziness, fainting, confusion or delirium in 26% in BOSTON; no driving or hazardous activities until these resolve.
- Harm to an unborn baby. Effective contraception for women who can become pregnant and for men with such partners, during treatment and for 1 week after.
- Cataracts. New or worsening cataracts needing treatment in 22% in BOSTON, with a median onset of about 228 days.
- Complete blood count with differential at baseline and during treatment, more often in the first 3 months
- Sodium and other blood chemistries, more often in the first 2 months
- Body weight, nutrition and fluid status
- Signs of infection and bleeding
- Eye exam by an eye specialist if vision changes occur
Xpovio has no boxed warning and no contraindications[1]. Its label lists 8 warnings and precautions[1]:
- Low platelets (thrombocytopenia): 92% in BOSTON, with grade 3 to 4 in 43%; fatal bleeding occurred in 2% of people with low platelets[1].
- Low neutrophils (neutropenia): 48% in BOSTON, with grade 3 to 4 in 12%[1].
- Stomach and gut effects: nausea in 50%, diarrhea in 32%, poor appetite in 35% and weight loss in 26% in BOSTON[1].
- Low blood sodium (hyponatremia): 58% in BOSTON, with grade 3 to 4 in 14%[1].
- Serious infections: any infection in 69% and grade 3 or higher in 32% in BOSTON; deaths from infection occurred in 3.1%[1].
- Neurological effects such as dizziness, fainting, confusion and delirium: 26% in BOSTON, severe in 3.6%[1].
- Harm to an unborn baby: effective contraception is advised during treatment and for 1 week after the last dose[1].
- Cataracts: new or worsening cataracts needing treatment in 22% in BOSTON[1].
In STORM, the trial of the twice-weekly Xpovio and dexamethasone regimen in heavily pretreated myeloma, fatal adverse reactions occurred in 9% of people[1]. In BOSTON, serious adverse reactions occurred in 52% of people on Xpovio, bortezomib and dexamethasone, and fatal adverse reactions in 6%[1].
With bortezomib and dexamethasone, the most common side effects (20% or more) were tiredness, nausea, decreased appetite, diarrhea, nerve damage in the hands and feet (peripheral neuropathy), upper respiratory infection, weight loss, cataract and vomiting[1]. Grade 2 or higher peripheral neuropathy was less frequent with weekly Xpovio, bortezomib and dexamethasone (21%) than with twice-weekly bortezomib and dexamethasone (34%)[1].
People 65 and older in BOSTON stopped Xpovio for side effects more often than younger people (28% against 13%)[1].
This is not a complete list of side effects. Talk to your doctor or pharmacist about what to expect and when to seek medical attention.
Taking Selinexor
Xpovio is a tablet taken by mouth at home, swallowed whole with water at about the same time of day[1]. The schedule depends on the combination[1]:
Treatment continues until the myeloma progresses or side effects become unacceptable[1]. In BOSTON, 64% of people had their Xpovio dose lowered for side effects, most often for low platelets[1]. People with severe liver impairment start at a lower dose[1].
The label calls for anti-nausea medicine, including a 5-HT3 blocker, before and during treatment, and advises enough fluids and calories throughout[1]. A missed or vomited dose is not made up; the next dose is taken at the next scheduled time[1]. Tablets come in 10mg, 20mg, 40mg, 50mg, 60mg and 80mg strengths in blister packs[1]. Xpovio has no REMS program[1].
Availability and cost
Only available as the brand-name product.
Help paying for Xpovio
With private insurance, the drugmaker's copay card can lower what you pay for Xpovio. Drugmaker copay cards can't be used with Medicare, Medicaid or TRICARE, but charity funds often can. Of the 5 charity funds for Multiple Myeloma, 1 was open on October 26, 2026. Pick your insurance below to see which offers fit you.
- Copay help
The Xpovio Copay Program may let eligible commercially insured patients pay as little as $5 per prescription. The program pays up to $8,000 a month, with an annual cap of $25,000, and other restrictions apply. Copay questions go to 1-844-243-7949, 8 AM to 8 PM ET, Monday through Friday.
For: private insurance · source - Free medicine program
The KaryForward Patient Assistance Program (PAP) supplies Xpovio to eligible patients after a review of household income, which can include tax or Social Security documents and an Experian Income View check. The prescriber certifies that no payer will be billed for drug provided by the PAP.
The official page does not say who qualifies. Ask the program. · source - Insurance and case manager help
KaryForward offers insurance verification, benefit investigation, prior authorization and appeal help, a nurse case manager, and information about independent third-party copay foundations. A QuickStart prescription for a 7-day supply can be requested on the same form. Call 1-877-KARY4WD (1-877-527-9493), Monday through Friday, 8 AM to 8 PM ET.
For: private insurance, Medicare, Medicaid, no insurance · source
Good to know: The prescriber's office enrolls the patient with the KaryForward enrollment form (fax 1-833-589-1603) or online, and every program has eligibility rules. The enrollment form is dated November 2022, so details may have changed. Karyopharm's pages do not state who qualifies for the PAP by income, or whether the copay program excludes government insurance. The KaryForward and Xpovio websites load by script and could not be read directly.
Charity funds for Multiple Myeloma
- From a charity · HealthWell FoundationMultiple Myeloma (Medicare Access) fundOpen
Pays for: Copays, premiums or other treatment costs. Medicare patients only.
Clinical trial results
BOSTON (NCT03110562) randomized 402 adults who had received 1 to 3 prior therapies to weekly Xpovio with bortezomib and dexamethasone, or twice-weekly bortezomib and dexamethasone[1][5]. Results were published in The Lancet in 2020[7]. Results from the label, at a median follow-up of 15.1 months[1]:
About 70% of BOSTON patients had received bortezomib before, and 6% or fewer had received daratumumab[1].
STORM (NCT02336815) was a single-arm phase 2b study of Xpovio 80mg twice weekly with dexamethasone[1][6]. Its results were published in the New England Journal of Medicine in 2019[8]. The approval rests on 83 people whose myeloma was refractory to bortezomib, carfilzomib, lenalidomide, pomalidomide and daratumumab[1]. Results from the label[1]:
STORM had no comparison group, so it shows response rates rather than a survival difference[1].
Development history
Karyopharm Therapeutics holds the US application for Xpovio (NDA 212306), and its approval history is listed on Drugs@FDA[2]:
- July 3, 2019: first approval, under accelerated approval, with dexamethasone for adults who had received at least 4 prior therapies and whose myeloma was refractory to 2 proteasome inhibitors, 2 immunomodulatory drugs and an anti-CD38 antibody[2][3].
- June 22, 2020: accelerated approval for relapsed or refractory diffuse large B-cell lymphoma (DLBCL), a different blood cancer[2][4].
- December 18, 2020: approval with bortezomib and dexamethasone after at least 1 prior therapy, based on BOSTON; the FDA letter states this fulfilled the confirmation requirement for the 2019 accelerated approval[3].
- April 2026: the FDA approved Karyopharm's request to remove the DLBCL indication, and released the company from the confirmatory lymphoma trials[4][1].
The myeloma indications were not affected by the DLBCL withdrawal, and Drugs@FDA lists all 6 tablet strengths as prescription products, which means they are currently marketed[2][1]. In the European Union, selinexor is sold as Nexpovio, which received conditional authorization on March 26, 2021, and full authorization on July 18, 2022, according to the EMA[9].
Explore Multiple Myeloma trials
Other Multiple Myeloma treatments
Xpovio blocks XPO1, a nuclear export protein, which is a different target from proteasome inhibitors, immunomodulatory drugs and anti-CD38 antibodies[1]. Xpovio is a tablet taken by mouth, and on its label it is always combined with dexamethasone, with or without the proteasome inhibitor bortezomib[1]. BOSTON compared Xpovio with bortezomib and dexamethasone against bortezomib and dexamethasone alone, not against other newer drugs, so its place relative to them rests on separate trials[1].
CAR-T cell therapies and bispecific antibodies are separate classes whose own labels set when they can be used.
Common questions about Selinexor
▸What is Selinexor (Xpovio)?
Xpovio (selinexor) is an XPO1-blocking tablet used in combination for adults with previously treated multiple myeloma[1]. The FDA first approved Xpovio on July 3, 2019, under accelerated approval, with dexamethasone for heavily pretreated myeloma[2][3]. On December 18, 2020, the FDA approved Xpovio with bortezomib and dexamethasone after at least 1 prior therapy, which also confirmed the 2019 approval[3]. In the BOSTON trial, median progression-free survival was 13.9 months with Xpovio added to bortezomib and dexamethasone, against 9.5 months without it[1]. Xpovio has no boxed warning, and its main label warnings are low platelets, low white cells, nausea and weight loss, low sodium, infections, confusion or dizziness, and cataracts[1]. Xpovio is not approved for newly diagnosed myeloma, and its separate lymphoma (DLBCL) approval was withdrawn in April 2026 at Karyopharm's request[1][4].
▸How does Selinexor work?
Healthy cells and cancer cells move proteins in and out of the nucleus, the compartment that holds DNA. A carrier protein called exportin 1 (XPO1) ships many of them out, including tumor suppressor proteins, which normally act as brakes on cell growth[1].
Xpovio blocks XPO1, according to the label's lab studies[1]:
- Tumor suppressor proteins build up inside the nucleus, where they can work[1].
- Levels of cancer-driving proteins such as c-myc and cyclin D1 drop[1].
- Myeloma cells stop dividing and undergo apoptosis, a built-in form of cell death[1].
In lab and animal models, Xpovio worked together with dexamethasone or bortezomib, including in myeloma resistant to proteasome inhibitors[1]. On its label, Xpovio is always given with dexamethasone, with or without bortezomib[1].
▸What are the side effects of Selinexor?
Xpovio has no boxed warning and no contraindications[1]. Its label lists 8 warnings and precautions[1]: Low platelets (thrombocytopenia): 92% in BOSTON, with grade 3 to 4 in 43%; fatal bleeding occurred in 2% of people with low platelets[1]. Low neutrophils (neutropenia): 48% in BOSTON, with grade 3 to 4 in 12%[1]. Stomach and gut effects: nausea in 50%, diarrhea in 32%, poor appetite in 35% and weight loss in 26% in BOSTON[1]. Low blood sodium (hyponatremia): 58% in BOSTON, with grade 3 to 4 in 14%[1]. Serious infections: any infection in 69% and grade 3 or higher in 32% in BOSTON; deaths from infection occurred in 3.1%[1]. Neurological effects such as dizziness, fainting, confusion and delirium: 26% in BOSTON, severe in 3.6%[1]. Harm to an unborn baby: effective contraception is advised during treatment and for 1 week after the last dose[1]. Cataracts: new or worsening cataracts needing treatment in 22% in BOSTON[1].
In STORM, the trial of the twice-weekly Xpovio and dexamethasone regimen in heavily pretreated myeloma, fatal adverse reactions occurred in 9% of people[1]. In BOSTON, serious adverse reactions occurred in 52% of people on Xpovio, bortezomib and dexamethasone, and fatal adverse reactions in 6%[1].
With bortezomib and dexamethasone, the most common side effects (20% or more) were tiredness, nausea, decreased appetite, diarrhea, nerve damage in the hands and feet (peripheral neuropathy), upper respiratory infection, weight loss, cataract and vomiting[1]. Grade 2 or higher peripheral neuropathy was less frequent with weekly Xpovio, bortezomib and dexamethasone (21%) than with twice-weekly bortezomib and dexamethasone (34%)[1].
People 65 and older in BOSTON stopped Xpovio for side effects more often than younger people (28% against 13%)[1].
▸How is Selinexor taken?
Xpovio is a tablet taken by mouth at home, swallowed whole with water at about the same time of day[1]. The schedule depends on the combination[1]:
- With bortezomib and dexamethasone (XVd): 100mg once a week, with bortezomib 1.3mg/m2 under the skin once a week for 4 weeks out of 5, and dexamethasone 20mg twice a week[1].
- With dexamethasone alone (Xd): 80mg on days 1 and 3 of each week, with dexamethasone 20mg alongside each dose[1].
Treatment continues until the myeloma progresses or side effects become unacceptable[1]. In BOSTON, 64% of people had their Xpovio dose lowered for side effects, most often for low platelets[1]. People with severe liver impairment start at a lower dose[1].
The label calls for anti-nausea medicine, including a 5-HT3 blocker, before and during treatment, and advises enough fluids and calories throughout[1]. A missed or vomited dose is not made up; the next dose is taken at the next scheduled time[1]. Tablets come in 10mg, 20mg, 40mg, 50mg, 60mg and 80mg strengths in blister packs[1]. Xpovio has no REMS program[1].
▸Is Selinexor FDA approved?
Yes, Selinexor (Xpovio) is FDA approved (2019) for the treatment of Multiple Myeloma.
▸Is Xpovio chemotherapy?
The Xpovio label calls selinexor a nuclear export inhibitor, a targeted tablet that blocks the XPO1 protein[1].
How it works: Blocking XPO1 keeps tumor suppressor proteins inside the nucleus, where they push myeloma cells to stop growing and die[1].
Combination: Xpovio is always taken with dexamethasone, and in one regimen also with bortezomib[1].
Source: Xpovio prescribing information (DailyMed)
▸How often do you take Xpovio?
Xpovio is taken once a week with bortezomib and dexamethasone, or twice a week with dexamethasone alone[1].
With bortezomib: 100mg once a week, on day 1 of each week[1].
With dexamethasone only: 80mg on days 1 and 3 of each week[1].
Missed dose: The label says to skip it and take the next dose at the next scheduled time[1].
Source: Xpovio prescribing information (DailyMed)
▸Why does Xpovio cause nausea and weight loss?
The label lists stomach and gut effects as a main warning, and nausea was one of the most common side effects in both trials[1].
How often: In BOSTON, nausea affected 50%, poor appetite 35% and weight loss 26%[1].
Timing: Nausea started at a median of 6 days in BOSTON[1].
Prevention: The label calls for anti-nausea medicine before and during treatment, plus enough fluids and calories[1].
Care team: Dose changes for these effects are decided by the prescribing doctor[1].
Source: Xpovio prescribing information (DailyMed)
▸Is Xpovio still approved for lymphoma?
No, the FDA removed the Xpovio lymphoma (DLBCL) indication in April 2026 at Karyopharm's request[4].
Background: The DLBCL use had accelerated approval from June 22, 2020, pending confirmatory trials[4].
Myeloma: Both myeloma uses remain on the current label[1].
Source: FDA supplement approval letter, NDA 212306/S-018; Xpovio prescribing information (DailyMed)
▸Is there copay help for Xpovio?
Yes, eligible commercially insured patients may pay as little as $5 per prescription through the Xpovio Copay Program[10].
Limits: The program pays up to $8,000 a month, with a $25,000 annual cap, and other restrictions apply[10].
Other help: KaryForward also runs a Patient Assistance Program and points people to independent copay foundations[11].
Phone: 1-877-527-9493, or 1-844-243-7949 for copay questions[11][10].
Source: Xpovio Copay Program page and KaryForward enrollment form (Karyopharm)
Sources and references
Every factual claim on this page is drawn from the public sources listed below. Click any reference to open the original document.
- U.S. National Library of Medicine, DailyMed (Karyopharm Therapeutics Inc.) · 2026-05. XPOVIO (selinexor) tablets, full prescribing information. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f6dd2682-75a6-4863-90a8-a3197f6f78a8
- U.S. Food and Drug Administration · 2026-04. Drugs@FDA: XPOVIO, NDA 212306, approval history. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=212306
- U.S. Food and Drug Administration · 2020-12-18. NDA 212306/S-005 supplement approval and fulfillment of postmarketing requirement (XPOVIO with bortezomib and dexamethasone). https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2020/212306Orig1s005ltr.pdf
- U.S. Food and Drug Administration · 2026-04-30. NDA 212306/S-018 supplement approval and release from postmarketing requirement (removal of DLBCL indication). https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2026/212306Orig1s018ltr.pdf
- ClinicalTrials.gov · 2024-08-21. Bortezomib, Selinexor, and Dexamethasone in Patients With Multiple Myeloma (BOSTON). https://clinicaltrials.gov/study/NCT03110562
- ClinicalTrials.gov · 2023-01-26. Selinexor Treatment of Refractory Myeloma (STORM). https://clinicaltrials.gov/study/NCT02336815
- The Lancet 396:1563-1573 · 2020-11-14. Once-per-week selinexor, bortezomib, and dexamethasone versus twice-per-week bortezomib and dexamethasone in patients with multiple myeloma (BOSTON): a randomised, open-label, phase 3 trial. https://doi.org/10.1016/S0140-6736(20)32292-3
- New England Journal of Medicine 381:727-738 · 2019-08-22. Oral Selinexor-Dexamethasone for Triple-Class Refractory Multiple Myeloma. https://doi.org/10.1056/NEJMoa1903455
- European Medicines Agency · 2026-08-05. Nexpovio (selinexor): EPAR overview and authorisation details. https://www.ema.europa.eu/en/medicines/human/EPAR/nexpovio
- Karyopharm Therapeutics (KaryForward) · 2025-10. Welcome to the XPOVIO Copay Program. https://copayportal.paysign.com/KaryForward/index.html
- Karyopharm Therapeutics · 2022-11. KaryForward Patient Support enrollment form. https://www.xpovio.com/content/pdf/karyforward-enrollment-form.pdf