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Patients were randomized to Rux placebo vs Rux and selinexor. At week 24, spleen volume reduction ≥35% (SVR35) was achieved in 49.8% of the selinexor plus ruxolitinib group vs 28.0% of the placebo plus ruxolitinib group. Symptom scores improved from baseline in both groups (−9.9 selinexor plus ruxolitinib, −10.9 placebo plus ruxolitinib), with no significant between-group difference will need long term follow up to assess the symptoms relief and the clonal regression.