Myeloma XIV: Frailty-adjusted Therapy in Transplant Non-Eligible Patients With Newly Diagnosed Multiple Myeloma

Multiple Myeloma Clinical Trial

— FiTNEss  

Official title:

Myeloma XIV: A Phase III Trial to Compare Standard and Frailty-adjusted Induction Therapy With Ixazomib, Lenalidomide and Dexamethasone (IRD) and Maintenance Lenalidomide (R) to Lenalidomide Plus Ixazomib (R+I)

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03720041
• Other study ID #: MyelomaXIV
• Status: Recruiting
• Phase: Phase 3
• Start date: August 4, 2020
• Est. completion date: December 2024

Study information

• Verified date: December 2020
• Source: University of Leeds
• Contact: Rowena Henderson
• Phone: +44 (0) 113 343 1159
• Email: ctru_myelomaxiv[@]leeds.ac.uk
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Trial Title:

FiTNEss (UK-MRA Myeloma XIV) - Frailty-adjusted therapy in Transplant Non-Eligible patients with newly diagnosed Multiple Myeloma

Overview:

A phase III, multi-centre, randomised controlled trial to compare standard (reactive) and frailty-adjusted (adaptive) induction therapy delivery with the novel triplet ixazomib, lenalidomide and dexamethasone (IRD), and to compare maintenance lenalidomide (R) to lenalidomide plus ixazomib (R+I) in patients with newly diagnosed multiple myeloma not suitable for a stem cell transplant.

All participants receive induction treatment with ixazomib, lenalidomide and dexamethasone and are randomised on a 1:1 basis at trial entry to the use of frailty score-adjusted up-front dose reductions vs. standard up-front dosing followed by toxicity dependent reactive dose-modifications during therapy. Following 12 cycles of induction treatment participants alive and progression-free undergo a second randomisation on a 1:1 basis to maintenance treatment with lenalidomide plus placebo versus lenalidomide plus ixazomib. Participants and their treating physicians will be blinded to maintenance allocation.

Participant population:

• Newly diagnosed as having Multiple Myeloma (MM) according to the updated IMWG diagnostic criteria 2014 (see Appendix 1 for criteria)

• Not eligible for stem cell transplant

• Aged at least 18 years

• Able to provide written informed consent

Number of participants:

740 participants will be entered into the trial at Randomisation 1 (R1), with 478 participants at Randomisation 2 (R2).

Objectives:

The primary objectives of this study are to determine:

• Early treatment cessation (within 60 days of randomisation) for standard versus frailty-adjusted up-front dosing

• Progression-free survival (PFS, from maintenance randomisation) for lenalidomide + placebo (R) versus lenalidomide + ixazomib (R+I)

The secondary objectives of this study are to assess progression-free survival (PFS) for standard versus frailty-adjusted up-front dosing reductions, time to progression, time to 2nd PFS event (PFS2), overall survival (OS), survival after progression, deaths within 12 months of R1, overall response rate (ORR), attainment of ≥VGPR, attainment of MRD negativity, duration of response, time to improved response, time to next treatment, treatment compliance and total amount of therapy delivered, toxicity & safety including the incidence of SPMs, Quality of Life (QoL), cost effectiveness of standard versus frailty-adjusted up-front dosing of IRD and cost-effectiveness of R + I versus R.

Exploratory objectives are prospective validation of a novel frailty risk score (UK-MRA Myeloma Risk Profile - MRP), usefulness of Karnofsky Performance Status (PS), and association of molecular subgroups with response, PFS and OS.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 740
• Est. completion date: December 2024
• Est. primary completion date: December 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Eligibility criteria for Randomisation 1 (R1) Participants must meet all of the following inclusion criteria and none of the exclusion criteria.

Inclusion criteria for R1

1. Newly diagnosed as having MM according to the updated IMWG diagnostic criteria 2014 requiring treatment.

2. Not eligible for stem cell transplant.

3. Aged at least 18 years.

4. Meet all of the following blood criteria within 14 days before R1:

Haematological:

1. Absolute neutrophil count (ANC) = 1 x 10^9/L. Unless the participant has a known/suspected diagnosis of familial or racial neutropenia in which case an ANC = 0.75 x 10^9/L is allowed. The use of growth factor support is permitted.

2. Platelet count = 50 x 10^9/L, or, in the case of heavy bone marrow infiltration (= 50%) which in the opinion of the investigator is the cause of the thrombocytopenia and provided appropriate supportive measures and patient monitoring are in place, platelet count = 30 x 10^9/L is permitted. Please note: Platelet transfusions are not allowed = 3 days prior to randomisation in order to meet these values.

3. Haemoglobin = 80 g/L. The use of red blood cell transfusions is permitted.

Biochemical:

4. Total bilirubin = 3 x upper limit of normal (ULN).

5. Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) = 3 x ULN.

5. Meet the pregnancy prevention requirements:

Female participants who:

1. Are not of childbearing potential, OR

2. If they are of childbearing potential, agree to practice 2 effective methods of contraception, at the same time, from the time of signing the informed consent form until 90 days after the last dose of study drug, OR

3. Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g. calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.)

Male participants, even if surgically sterilised (i.e. status post-vasectomy), must agree to one of the following:

1. Agree to practice effective barrier contraception during the entire study treatment period and through 90 days after the last dose of study drug, OR

2. Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence (e.g. calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception).

Contraception for female and male participants must be in accordance with (and participants must consent to) the Celgene-approved Pregnancy Prevention Programme.

If female and of childbearing potential, they must have a negative pregnancy test performed by a healthcare professional in accordance with the Celgene Pregnancy Prevention Programme.

6. Able to provide written informed consent.

Exclusion criteria for R1

1. Smouldering MM, MGUS, solitary plasmacytoma of bone, or extramedullary plasmacytoma (without evidence of MM).

2. Received previous treatment for MM, with the exception of local radiotherapy to relieve bone pain or spinal cord compression, prior bisphosphonate treatment, or corticosteroids as long as the total dose does not exceed the equivalent of 160 mg dexamethasone.

3. Known resistance, intolerance or sensitivity to any component of the planned therapies.

4. Prior or concurrent invasive malignancies except the following:

• Adequately treated basal cell or squamous cell skin cancer;

• Incidental finding of low grade (Gleason 3+3 or less) prostate cancer requiring no intervention;

• Adequately treated carcinoma in situ of the breast or cervix no longer requiring medical or surgical intervention;

• Any cancer from which the subject has been disease-free for at least 3 years.

5. Pregnant, lactating or breastfeeding female participants.

6. Major surgery within 14 days before randomisation. This would include surgical intervention for relief of cord compression but does not include vertebroplasty or kyphoplasty.

7. Systemic treatment, within 14 days before the first dose of ixazomib with strong CYP3A inducers (e.g. rifampicin, rifabutin, carbamazepine, phenytoin, phenobarbital), or use of St. John's wort.

8. Any concomitant drug therapy which, in the opinion of the investigator, may lead to an unacceptable interaction with any of the agents ixazomib, lenalidomide, dexamethasone, and that cannot be safely stopped prior to trial entry. Full details of interactions can be found in the SPCs.

9. Known gastrointestinal (GI) disease or GI procedure that could interfere with the oral absorption or tolerance of trial treatment, including difficulty swallowing.

10. = Grade 2 peripheral neuropathy.

11. Known HIV positive or known hepatitis B surface antigen positive or hepatitis C antibody positive.

12. Active systemic infection.

13. Any other medical or psychiatric condition which, in the opinion of the investigator, contraindicates the participant's participation in this study.

Eligibility criteria for Randomisation 2 (R2) Participants must meet all of the following inclusion criteria and none of the exclusion criteria.

Inclusion criteria for R2

1. Randomised into the FiTNEss (Myeloma XIV) trial and received induction chemotherapy with ixazomib and lenalidomide continued for 12 cycles.

2. Achieved at least MR at the end of IRD induction according to the IMWG Uniform Response Criteria for Multiple Myeloma, with no evidence of progression prior to R2.

3. Meet all of the following blood criteria within 14 days before R2:

Haematological:

1. Absolute neutrophil count (ANC) = 1 x 10^9/L. Unless the participant has a known/suspected diagnosis of familial or racial neutropenia in which case an ANC = 0.75 x 10^9/L is allowed. The use of growth factor support is permitted.

2. Platelet count = 50 x 10^9/L. Please note: Platelet transfusions are not allowed = 3 days prior to randomisation in order to meet these values.

3. Haemoglobin = 80 g/L. The use of red blood cell transfusions is permitted.

Biochemical:

4. Total bilirubin = 3 x upper limit of normal (ULN).

5. Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) = 3 x ULN.

Exclusion criteria for R2

1. Received any anti-myeloma therapy other than their randomised trial treatment, with the exception of local radiotherapy to relieve bone pain (in the absence of disease progression), or bisphosphonate treatment.

2. SD or disease progression according to the IMWG Uniform Response Criteria for Multiple Myeloma.

3. Known resistance, intolerance or sensitivity to ixazomib or lenalidomide that required cessation of either agent during induction.

4. Developed any malignancy since R1 except the following:

• Adequately treated basal cell or squamous cell skin cancer;

• Incidental finding of low grade (Gleason 3+3 or less) prostate cancer requiring no intervention;

• Adequately treated carcinoma in situ of the breast or cervix no longer requiring medical or surgical intervention.

5. Pregnant, lactating or breastfeeding female participants.

6. Major surgery within 14 days before randomisation. This does not include vertebroplasty or kyphoplasty.

7. Systemic treatment, within 14 days before the first dose of ixazomib with strong CYP3A inducers (e.g. rifampicin, rifabutin, carbamazepine, phenytoin, phenobarbital), or use of St. John's wort.

8. Known gastrointestinal (GI) disease or GI procedure that could interfere with the oral absorption or tolerance of trial treatment, including difficulty swallowing.

9. = Grade 2 peripheral neuropathy, or grade 1 with pain.

10. Known HIV positive or known hepatitis B surface antigen positive or hepatitis C antibody positive.

11. Active systemic infection.

12. Any other medical or psychiatric condition which, in the opinion of the investigator, contraindicates the participant's continued participation in this study.

Related Conditions & MeSH terms

• Frailty
• Multiple Myeloma
• Neoplasms, Plasma Cell

Intervention

Drug:
• R1: Ixazomib, Lenalidomide, Dexamethasone (IRD) induction therapy - reactive arm
In the reactive arm at Randomisation 1, participants will receive IRD induction therapy with standard up-front dosing, with toxicity assessed at each cycle and doses adjusted in accordance with the guidelines given in the trial protocol. All participants will be given the following starting doses: Ixazomib: 4mg/day on days 1, 8 and 15, taken orally Lenalidomide: 25mg/day on days 1-21, taken orally Dexamethasone: 40mg on days 1, 8, 15 and 22 for participants aged =75 years, or 20mg on days 1, 8, 15 and 22 for participants aged > 75 years; taken orally Participants will receive this dosing regimen for 12 cycles of induction treatment, in the absence of disease progression or unacceptable toxicity. Each cycle is 28 days.
• R1: Ixazomib, Lenalidomide, Dexamethasone (IRD) induction therapy - adaptive arm
In the adaptive arm at Randomisation 1, participants will receive IRD induction therapy with up-front dose reductions adjusted according to their frailty score: fit, unfit, or frail. The starting doses for each frailty category are described below: Fit category: Ixazomib: 4mg/day on days 1, 8 and 15, taken orally Lenalidomide: 25mg on days 1-21, taken orally Dexamethasone: 40mg on days 1, 8, 15 and 22, taken orally Unfit category: Ixazomib: 4mg/day on days 1, 8 and 15, taken orally Lenalidomide: 15mg on days 1-21, taken orally Dexamethasone: 20mg on days 1, 8, 15 and 22, taken orally Frail category: Ixazomib: 4mg/day on days 1, 8 and 15, taken orally Lenalidomide: 10mg on days 1-21, taken orally Dexamethasone: 10mg on days 1, 8, 15 and 22, taken orally Participants will receive this dosing regimen for 12 cycles of induction treatment, in the absence of disease progression or unacceptable toxicity. Each cycle is 28 days.
• R2: Lenalidomide plus placebo maintenance
Participants randomised to receive lenalidomide plus placebo maintenance at Randomisation 2 will receive the following starting doses: Lenalidomide: 10mg*/day on days 1-21, taken orally Placebo: 4mg*/day on days 1, 8 and 15 * or final dose administered at the end of induction treatment if lower. This dosing regimen is continued for every maintenance cycle. Participants will continue maintenance treatment until disease progression or intolerance/unacceptable toxicity. Each maintenance cycle is 28 days. Randomisation 2 is double-blind - participants and their treating clinicians will be blinded to maintenance allocation.
• R2: Lenalidomide + ixazomib maintenance
Participants randomised to receive lenalidomide plus ixazomib maintenance at Randomisation 2 will receive the following starting doses: Lenalidomide: 10mg*/day on days 1-21, taken orally Ixazomib: 4mg*/day on days 1, 8 and 15 * or final dose administered at the end of induction treatment if lower. This dosing regimen is continued for every maintenance cycle. Participants will continue maintenance treatment until disease progression or intolerance/unacceptable toxicity. Each maintenance cycle is 28 days. Randomisation 2 is double-blind - participants and their treating clinicians will be blinded to maintenance allocation.

Locations

Country	Name	City	State
United Kingdom	Aberdeen Royal Infirmary	Aberdeen
United Kingdom	Nevill Hall Hospital	Abergavenny
United Kingdom	Wrightington Hosptial	Appley Bridge
United Kingdom	Ysbyty Gwynedd	Bangor
United Kingdom	North Devon District Hospital	Barnstaple
United Kingdom	Furness General Hospital	Barrow In Furness
United Kingdom	Basingstoke and North Hampshire Hospital	Basingstoke
United Kingdom	Royal United Hospital	Bath
United Kingdom	Belfast City Hospital	Belfast
United Kingdom	Birmingham Heartlands Hospital	Birmingham
United Kingdom	Queen Elizabeth Hospital	Birmingham
United Kingdom	Royal Blackburn Hospital	Blackburn
United Kingdom	Blackpool Victoria Hospital	Blackpool
United Kingdom	Royal Bolton Hospital	Bolton
United Kingdom	Pilgrim Hospital	Boston
United Kingdom	Royal Bournemouth Hospital	Bournemouth
United Kingdom	Bradford Royal Infirmary	Bradford
United Kingdom	Bristol Haematology and Oncology Centre	Bristol
United Kingdom	Southmead Hospital	Bristol
United Kingdom	Queen's Hospital	Burton Upon Trent
United Kingdom	Kent and Canterbury Hospital	Canterbury
United Kingdom	Chelmsford & Essex Hospital	Chelmsford
United Kingdom	Cheltenham General Hospital	Cheltenham
United Kingdom	Countess of Chester Hospital	Chester
United Kingdom	St Richard's Hospital	Chichester
United Kingdom	Colchester General Hospital	Colchester
United Kingdom	University Hospital Coventry	Coventry
United Kingdom	Croydon University Hospital	Croydon
United Kingdom	Royal Derby Hospital	Derby
United Kingdom	Dorset County Hospital	Dorchester
United Kingdom	Russells Hall Hospital	Dudley
United Kingdom	Ninewells Hospital	Dundee
United Kingdom	Western General Hospital	Edinburgh
United Kingdom	Royal Devon & Exeter Hospital	Exeter
United Kingdom	Medway Maritime Hospital	Gillingham
United Kingdom	Gloucestershire Royal Hospital	Gloucester
United Kingdom	Grantham and District Hospital	Grantham
United Kingdom	Diana Princess of Wales Hospital	Grimsby
United Kingdom	Royal Surrey County Hospital	Guildford
United Kingdom	Calderdale Royal Hospital	Halifax
United Kingdom	Harrogate District Hospital	Harrogate
United Kingdom	Withybush General Hospital	Haverfordwest
United Kingdom	Hereford County Hospital	Hereford
United Kingdom	Huddersfield Royal Infirmary	Huddersfield
United Kingdom	Castle Hill Hospital	Hull
United Kingdom	Raigmore Hospital	Inverness
United Kingdom	Ipswich Hospital	Ipswich
United Kingdom	Airedale Hospital	Keighley
United Kingdom	Westmorland General Hospital	Kendal
United Kingdom	Kettering General Hospital	Kettering
United Kingdom	Kidderminster Hospital & Treatment Centre	Kidderminster
United Kingdom	Victoria Hospital	Kirkcaldy
United Kingdom	Royal Lancaster Infirmary	Lancaster
United Kingdom	St James's University Hospital	Leeds
United Kingdom	Leicester Royal Infirmary	Leicester
United Kingdom	Lincoln County Hospital	Lincoln
United Kingdom	Aintree University Hospital	Liverpool
United Kingdom	Royal Liverpool Hospital	Liverpool
United Kingdom	Guy's Hospital	London
United Kingdom	King's College Hospital	London
United Kingdom	Queen Elizabeth Hospital Greenwich	London
United Kingdom	St Bartholomew's Hospital	London
United Kingdom	University College Hospital	London
United Kingdom	University Hospital Lewisham	London
United Kingdom	Maidstone Hospital	Maidstone
United Kingdom	Manchester Royal Infirmary	Manchester
United Kingdom	James Cook University Hospital	Middlesbrough
United Kingdom	Freeman Hospital	Newcastle
United Kingdom	Royal Gwent Hospital	Newport
United Kingdom	North Tyneside General Hospital	North Shields
United Kingdom	Nottingham City Hospital	Nottingham
United Kingdom	Royal Oldham Hospital	Oldham
United Kingdom	Princess Royal University Hospital	Orpington
United Kingdom	Peterborough City Hospital	Peterborough
United Kingdom	Derriford Hospital	Plymouth
United Kingdom	Whiston Hospital	Prescot
United Kingdom	Royal Preston Hospital	Preston
United Kingdom	Royal Berkshire Hospital	Reading
United Kingdom	Alexandra Hospital	Redditch
United Kingdom	Glan Clwyd Hospital	Rhyl
United Kingdom	Queen's Hospital	Romford
United Kingdom	Salford Royal Hospital	Salford
United Kingdom	Salisbury District Hospital	Salisbury
United Kingdom	Scarborough General Hospital	Scarborough
United Kingdom	Scunthorpe General Hospital	Scunthorpe
United Kingdom	Royal Hallamshire Hospital	Sheffield
United Kingdom	Royal Shrewsbury Hospital	Shrewsbury
United Kingdom	Southampton General Hospital	Southampton
United Kingdom	St Helens Hospital	St Helens
United Kingdom	Stafford County Hospital	Stafford
United Kingdom	Stepping Hill Hospital	Stockport
United Kingdom	Royal Stoke University Hospital	Stoke-on-Trent
United Kingdom	Sunderland Royal Hospital	Sunderland
United Kingdom	Good Hope Hospital	Sutton Coldfield
United Kingdom	Singleton Hospital	Swansea
United Kingdom	St George's Hospital	Tooting
United Kingdom	Torbay District General Hospital	Torquay
United Kingdom	Royal Cornwall Hospital	Truro
United Kingdom	Tunbridge Wells Hospital	Tunbridge Wells
United Kingdom	Hillingdon Hospital	Uxbridge
United Kingdom	Pinderfields General Hospital	Wakefield
United Kingdom	Warwick Hospital	Warwick
United Kingdom	Sandwell General Hospital	West Bromwich
United Kingdom	Royal Albert Edward Infirmary	Wigan
United Kingdom	Royal Hampshire County Hospital	Winchester
United Kingdom	New Cross Hospital	Wolverhampton
United Kingdom	Worcestershire Royal Hospital	Worcester
United Kingdom	Worthing Hospital	Worthing
United Kingdom	Wrexham Maelor Hospital	Wrexham
United Kingdom	York Hospital	York

Sponsors (4)

Lead Sponsor	Collaborator
University of Leeds	Cancer Research UK, Celgene, Takeda

Country where clinical trial is conducted

United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Novel frailty risk score (UK-MRA MRP)_composite measure	The prospective validation of a novel frailty risk score (UK Myeloma Research Alliance Myeloma Risk Profile (UK-MRA MRP)) will use the following measurements at baseline to categorise individuals into fit, intermediate-fitness and frail using the UK-MRA MRP: C-Reactive Protein (CRP),; Age,; Performance status on Eastern Cooperative Oncology Group (ECOG) scale (scoring from 0 to 5, with 0 - fully active and 5 = dead) and; Score on Revised International Staging System for Multiple Myeloma scale (ISS). The ISS score categorises newly-diagnosed myeloma patients into three groups (I, II, or III) depending on expected prognosis/overall survival based on measurements of serum beta-2 microglobulin and serum albumin.	Through study completion, up to 120 months
Other	Usefulness of Karnofsky PS_composite measure	The Karnofsky Performance Status will be contrasted with the Eastern Cooperative Oncology Group (ECOG) Performance Status to consider whether it can appropriately measure the performance status of patients with multiple myeloma.	Through study completion, up to 120 months
Primary	Randomisation 1: Number of participants with early treatment cessation	Early treatment cessation is defined as a binary endpoint. Participants will be defined to have experienced an event if they die, progress, or are withdrawn from treatment (by a treating clinician) or withdraw consent for trial treatment, within 60 days of Randomisation 1.	Within 60 days of Randomisation 1
Primary	Randomisation 2: Progression-free survival (PFS-R2)	PFS-R2 is defined as the time from Randomisation 2 to the time of first documented evidence of disease progression or death from any cause. Individuals who are lost to follow-up or progression-free at the time of analysis will be censored at their last known date to be alive and progression-free. Disease progression is defined according to the IMWG Uniform Response Criteria for Multiple Myeloma.	The time from the date of Randomisation 2 to the date of first documented evidence of disease progression or death from any cause, up to 120 months
Secondary	Progression-free survival (PFS-R1)	PFS-R1 is defined as the time from R1 to the time of first documented evidence of disease progression or death from any cause. Individuals who are lost to follow-up or progression-free at the time of analysis will be censored at their last known date to be alive and progression-free. Disease progression is defined according to the IMWG Uniform Response Criteria for Multiple Myeloma.	The time from the date of Randomisation 1 to the date of first documented evidence of disease progression or death from any cause, up to 120 months
Secondary	Time to disease progression	Time to disease progression is defined for both Randomisation 1 and Randomisation 2 as the time from randomisation to the date of first documented evidence of disease progression. Participants who die prior to documentation of disease progression will be censored in the analysis at their date of death. Participants not reaching disease progression at the time of analysis will be censored at the last date known to be progression-free. Participants dying from causes not primarily due to progression will also be censored.	The time from the date of randomisation to the date of first documented evidence of disease progression, up to 120 months
Secondary	Progression-free survival two (PFS2)	For both Randomisation 1 and Randomisation 2, progression-free survival two is defined as the time from randomisation to the time of the second documented disease progression. Individuals who are lost to follow-up or second progression-free at the time of analysis will be censored at their last known date to be alive and second progression-free.	The time from the date of randomisation to the date of the second documented disease progression, up to 120 months
Secondary	Overall survival (OS)	Overall survival is defined separately for each randomisation. In each case it is the time from randomisation to the time of death from any cause. Individuals who are lost to follow-up or still alive at the time of analysis will be censored at their last known date to be alive.	The time from the date of randomisation to the date of death from any cause, up to 120 months
Secondary	Survival after progression	Survival after progression is defined from the date of first documented evidence of disease progression to the date of death from any cause. Individuals who are lost to follow-up or alive at the time of analysis will be censored at their last known date to be alive following their first documented evidence of disease progression.	The date of first documented evidence of disease progression to the date of death from any cause, up to 120 months
Secondary	Deaths within 12 months of Randomisation 1 (R1)	Deaths within 12 months of Randomisation 1 is defined as a binary endpoint. Participants will be defined to have experienced an event if they die within 12 months of Randomisation 1.	Within 12 months of Randomisation 1
Secondary	Overall response rate (ORR)	Overall response rate is defined as a categorical outcome consisting of whether a participant had Stringent Complete Response (sCR), Complete Response (CR), Very Good Partial Response (VGPR), Partial Response (PR), Minimal Response (MR), Stable Disease (SD) or Progressive Disease (PD) at the end of induction according to the IMWG Uniform Response Criteria for Multiple Myeloma.	From the date of Randomisation 1 to the end of 12 cycles of induction treatment (each induction cycle is 28 days)
Secondary	Attainment of =VGPR	Attainment of =VGPR is defined as a binary outcome of whether a participant had =VGPR (VGPR, CR, sCR) or	From the date of Randomisation 1 to the end of 12 cycles of induction treatment (each induction cycle is 28 days)
Secondary	Attainment of Minimal Residual Disease (MRD) negativity	Attainment of Minimal Residual Disease (MRD) negativity is defined as a binary endpoint. MRD negativity will be determined at the end of induction therapy and 12 months post Randomisation 2 according to the IMWG MRD criteria.	From the date of Randomisation 1 to the end of 12 cycles of induction treatment (each induction cycle is 28 days); and 12 months after the date of Randomisation 2
Secondary	Duration of response (DoR)	Duration of response is defined as the time from the first observation of response = Partial Response (PR), following Randomisation 1, to the time of first documented evidence of disease progression or death confirmed related to progression. Individuals who are lost to follow-up, or still alive and progression-free at the time of analysis will be censored at their last known date to be alive and progression-free. Individuals whose cause of death is unrelated to disease progression will be censored at their date of death.	The time from the date of the first observation of response = Partial Response following Randomisation 1, to the date of first documented evidence of disease progression or death confirmed related to progression, up to 120 months
Secondary	Time to improved response	Time to improved response is defined as the time from the date of Randomisation 2 to the date the response category is first improved based on the Modified International Uniform Response Criteria for Multiple Myeloma. Subjects without any improvement of the baseline status at Randomisation 2 will be censored at the last date of response assessment.	The time from the date of Randomisation 2 to the date the response category is first improved, up to 120 months
Secondary	Time to next treatment	Time to next treatment is defined as the time from Randomisation 1 to the start date of the next line of treatment or death from any cause.	The time from the date of Randomisation 1 to the start date of the next line of treatment or death from any cause, up to 120 months
Secondary	Treatment compliance and total amount of therapy delivered	In the first instance treatment compliance is defined as a binary outcome i.e. did the participant receive 12 cycles of induction treatment. The total amount of therapy delivered will be first defined as the number of induction and maintenance cycles which the participant received. This may be extended to consider the percentage of protocol dose delivered. For each treatment (ixazomib, lenalidomide, dexamethasone) this will be defined as the total dose received in a cycle compared to the total dose the participant should have received in the cycle without modifications, averaged across all cycles of treatment.	Number of induction and maintenance cycles a participant received (each cycle of induction or maintenance is 28 days), until disease progression, up to 120 months
Secondary	Incidence of treatment-emergent adverse events (Toxicity and safety, including incidence of second malignancies)	Toxicity & safety, including incidence of second malignancies Toxicity and safety will be reported based on the adverse events, as graded by CTCAE V5 and determined by routine clinical assessments at each centre. The number of SAEs will be reported according to MedDRA System Organ Class. All second primary malignancies will be reported based on information collected on the Case Report Form.	Baseline, end of each induction cycle (each induction cycle is 28 days), end of each maintenance cycle (each maintenance cycle is 28 days), until disease progression, up to 120 months
Secondary	EORTC QLQ-C30_questionnaire	European Organization for the Research & Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) is used to measure patient-assessed quality of life (QoL) at R1, after cycles 2, 4, 6 & 12 of induction, and after cycles 6 and 12 of maintenance (all cycles are 28 days).; The QLQ-C30 comprises multi-item scales & single-item measures: 5 functional scales (physical, role, cognitive, emotional, social), 3 symptom scales (fatigue, pain, nausea & vomiting), a global health status/QoL scale, & 6 single items assessing additional symptoms (dyspnoea, loss of appetite, insomnia, constipation & diarrhoea). All scales & single-item measures range in score from 0 to 100. A high scale score represents a higher response level: a high score for a functional scale represents a high/healthy level of functioning, a high score for the global health status/QoL represents a high quality of life, but a high score for a symptom scale/item represents a high level of symptomatology/problems.	Randomisation 1; after cycles 2, 4, 6 and 12 of induction treatment (each induction cycle is 28 days); after cycles 6 and 12 of maintenance treatment (each maintenance cycle is 28 days)
Secondary	EORTC QLQ-MY20_questionnaire	The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Multiple Myeloma Module (EORTC QLQ-MY20) is used to measure patient-assessed quality of life (QoL) at Randomisation 1, after cycles 2, 4, 6 and 12 of induction treatment (each induction cycle is 28 days), and after cycles 6 and 12 of maintenance treatment (each maintenance cycle is 28 days).; The EORTC QLQ-MY20 comprises 20 questions that address four myeloma-specific QoL domains: Disease Symptoms, Side Effects of Treatment, Future Perspectives, and Body Image. Disease Symptoms, Side Effects of Treatment, and Future Perspectives are all multi-item scales, and Body Image is a single-item scale. Domain scores are averaged and transformed linearly to a score ranging from 0-100. A high score for Disease Symptoms and Side Effects of Treatment represents a high level of symptomatology or problems, whereas a high score for Future Perspective and Body Image represents better outcomes.	Randomisation 1; after cycles 2, 4, 6 and 12 of induction treatment (each induction cycle is 28 days); after cycles 6 and 12 of maintenance treatment (each maintenance cycle is 28 days)
Secondary	EQ-5D-3L_questionnaire	The EuroQol 5 Dimension 3 Level questionnaire (EQ-5D-3L) will be used to measure participant-assessed quality of life at Randomisation 1, after cycles 2, 4, 6 and 12 of induction treatment (each induction cycle is 28 days), and after cycles 6 and 12 of maintenance treatment (each maintenance cycle is 28 days).; The EQ-5D-3L descriptive system comprises the following five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, and extreme problems. The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions. This decision results into a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state.	Randomisation 1; after cycles 2, 4, 6 and 12 of induction treatment (each induction cycle is 28 days); after cycles 6 and 12 of maintenance treatment (each maintenance cycle is 28 days)