Selinexor, High-Dose Melphalan, and Dexamethasone before Stem Cell Transplant in Treating Patients with Multiple Myeloma

Inclusion Criteria

• Patients with histologically confirmed multiple myeloma
• Achieving partial response (PR) or very good partial response (VGPR) with systemic chemotherapy
• Received less than 4 lines of anti-myeloma therapy
• Karnofsky performance status of >= 70%
• Adjusted diffusion capacity of the lung for carbon monoxide (DLCO), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC) >= 50% of predicted value (corrected for hemoglobin)
• Left ventricular ejection fraction (LVEF) >= 45%
• Total bilirubin =< 2 mg/dL; serum transaminases less than two times the institutional upper limit of normal (< 2 x upper limit of normal [ULN])
• Creatinine clearance >= 40 mL/min, estimated or calculated
• Signed informed consent form in accordance with institutional policies prior to the initiation of high-dose therapy

Exclusion Criteria

• Non-secretory multiple myeloma
• Patients who achieved complete response (CR) prior to autologous HCT
• Central nervous system (CNS) involvement
• Patients with uncontrolled bacterial, viral or fungal infections
• Myocardial infarction within 6 months prior to enrollment or has New York Heart Association (NYHA) class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities
• Patients with prior malignancies within the last 5 years except resected basal cell carcinoma or treated cervical carcinoma in situ
• Female patients who are pregnant (positive beta-human chorionic gonadotropin [B-HCG]) or breastfeeding
• Patients who have received other investigational drugs within 14 days prior to screening
• Prior autologous or allogeneic HCT
• Prior organ transplant or autoimmune disease requiring immunosuppressive therapy