A Study of Ixazomib+Daratumumab+Dexamethasone (IDd) in Relapsed and/or Refractory Multiple Myeloma (RRMM)

The regimen being tested in this study is the combination of ixazomib, daratumumab, and
dexamethasone. This study will look at the efficacy and safety of Ixazomib + Daratumumab +
Dexamethasone (IDd) in people who have relapsed and/or refractory multiple myeloma (RRMM).

The study will enroll approximately 60 patients. Participants will be assigned to the
treatment group:

• Ixazomib 4.0 mg + Daratumumab 16.0 mg/kg + Dexamethasone 20 mg

All participants will be asked to take Ixazomib on Days 1, 8 and 15 of each 28-day cycle plus
Daratumumab on Days 1, 8, 15 and 22 of each 28-day cycle for Cycles 1 and 2, on Days 1 and 15
of each 28-day cycle for Cycles 3 through 6 and on Day 1 of each 28-day cycle for Cycle 7 and
beyond plus Dexamethasone orally on Days 1, 2, 8, 9, 15, 16, 22 and 23 of each 28-day cycle.

This multi-center trial will be conducted worldwide. The overall time to participate in this
study is 5 years. Participants will make multiple visits to the clinic, and every 12 weeks
after PD until death or termination of the study by the sponsor.

Inclusion Criteria:

1. Have measurable disease by at least 1 of the following measurements:

- serum M-protein ≥1 gm/dL (≥10 gm/L).

- urine M-protein ≥200 mg/24 hours.

2. Have documented evidence of progressive disease (PD) on or after their last regimen as
defined by IMWG criteria. All participants must have received between 1 to 3 prior
therapies for MM (a prior therapy is defined as 2 or more cycles of therapy given as a
treatment plan for MM [eg, a single-agent or combination therapy or a sequence of
planned treatments such as induction therapy followed by autologous stem cell
transplant (SCT) and then consolidation and/or maintenance therapy]).

3. Have achieved a response (partial response (PR) or better) to at least 1 prior
therapy.

4. Have an Eastern Cooperative Oncology Group (ECOG) score of 0, 1, or 2.

5. Must meet the following laboratory criteria:

- Absolute neutrophil count (ANC) ≥1000/mm3.

- Platelet count ≥75,000/mm3.

- Total bilirubin ≤1.5 x the upper limit of the normal range (ULN) (except for
Gilbert syndrome: direct bilirubin ≤2 x ULN).

- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤3 x ULN.

- Calculated creatinine clearance ≥50 mL/min.

Exclusion Criteria:

1. Have undergone prior allogenic bone marrow transplantation.

2. Have received prior ixazomib at any time or daratumumab or other anti-CD38 therapies,
except as part of initial therapy if this was stopped to move on to SCT and the
participants did not progress on anti-CD38 treatment.

3. Are refractory to bortezomib or carfilzomib at the last exposure before this study
(defined as participants having PD while receiving bortezomib or carfilzomib therapy
or within 60 days after ending bortezomib or carfilzomib therapy).

4. Are planning to undergo SCT prior to PD on this study (ie, these participants should
not be enrolled in order to reduce disease burden prior to transplant).

5. Are receiving systemic treatment with strong CYP3A inducers (rifampin, rifapentine,
rifabutin, carbamazepine, phenytoin, phenobarbital, St. John's wort) within 14 days
before randomization.

6. Has received autologous SCT within 12 weeks before the date of study treatment.

7. With known chronic obstructive pulmonary disease (COPD) with a forced expiratory
volume in 1 second (FEV1) <50% of predicted normal. Note: FEV1 testing is required for
participants suspected of having COPD and participants must be excluded if FEV1 is
<50% of predicted normal.

- participants with Grade 2 or higher residual toxicities from prior therapy
(including Grade 2 or higher peripheral neuropathy or any grade neuropathy with pain;
excluding alopecia). This includes recovery from any major surgery. Note: Participants
with planned surgical to be conducted under local anesthesia may participate.
Kyphoplasty or vertebroplasty are not considered major surgery.

8. Has uncontrolled clinically significant cardiac disease, including myocardial
infarction within 6 months before date of study entry or unstable or uncontrolled
angina, congestive heart failure, New York Heart Association (NYHA) Class III-IV,
uncontrolled cardiac arrhythmia (Grade 2 or higher).

9. With ongoing or active systemic infection requiring intravenous (IV) medical
management, known human immunodeficiency virus (HIV-RNA) positive, known hepatitis B
surface antigen seropositive, or known hepatitis C virus-RNA positive. Note:
Participants who have positive hepatitis B core antibody can be enrolled but must have
hepatitis B virus-DNA negative. Participants who have positive hepatitis C antibody
can be enrolled but must have hepatitis C virus-RNA negative.

10. Diagnosed or treated for another malignancy within 2 years before randomization or
previously diagnosed with another malignancy and have any evidence of residual
disease. Participants with nonmelanoma skin cancer or carcinoma in situ of any type
are not excluded if they have undergone complete resection.