Study of Lenalidomide/Ixazomib/Dexamethasone/Daratumumab in Transplant-Ineligible Patients With Newly Diagnosed MM

Induction Phase: 28-day treatment cycle. Treatment continues until disease progression or for a maximum of 12 cycles as follows: Cycles 1-2: * Lenalidomide - 15 mg PO QD on Days 1-21 * Ixazomib - 4 mg PO on Days 1, 8, 15 * Daratumumab Subcutaneous - 15mL/1800mg on Days 1, 8, 15, 22 * Dexamethasone - 20 mg PO on Days 1, 2, 8, 9, 15, 16, 22, 23; For participants ≥75, dexamethasone administered on days 1, 8, 15, 22 Cycles 3-6: * Lenalidomide - 15 mg PO QD on Days 1-21 * Ixazomib - 4 mg PO on Days 1, 8, 15 * Daratumumab Subcutaneous - 15mL/1800mg on Days 1, 15 * Dexamethasone - 20 mg PO on Days 1, 2, 8, 9, 15, 16; For participants ≥75, dexamethasone administered on days 1, 8, 15 Cycles 7-12: * Lenalidomide - 15 mg PO QD on Days 1-21 * Ixazomib - 4 mg PO on Days 1, 8, 15 * Daratumumab Subcutaneous - 15mL/1800mg on Day 1 * Dexamethasone - 20 mg PO on Days 1, 2, 8, 9, 15, 16; For participants ≥75, dexamethasone administered on days 1, 8, 15 Maintenance Phase: 28-day treatment cycle. Treatment continues until progression or a maximum of 2 years of maintenance treatment: Arm A • Lenalidomide - 10 mg PO QD on Days 1-21 Arm B * Lenalidomide - 10 mg PO QD on Days 1-21 * Ixazomib - 3 mg (or last tolerated dose from the induction phase) PO on Days 1, 8, and 15 * Daratumumab Subcutaneous - 15mL/1800mg on Day 1 * Dexamethasone - 20mg PO on Day 1; Unless patient is ≥75 then 10mg po day 1 In the maintenance phase, dexamethasone, 20 mg PO orally or IV will be administered to patients as a pre-infusion medication prior to daratumumab dosing. When dexamethasone is reduced to 20 mg/week and is given as pre-infusion medication, patients may receive low-dose methylprednisolone (≤20 mg) orally (or equivalent in accordance with local standards) for the prevention of delayed IRRs as clinically indicated. If the investigator wishes to continue the maintenance regimen at the end of the 2 years maintenance treatment, patients may continue current maintenance as per standard of care.