Upon joining the study, you will be assigned to one of three treatment groups. The assignment will be done randomly, similar to flipping a coin.

The three possible treatment groups are: Arm A (receiving linvoseltamab alone), Arm B (receiving linvoseltamab combined with carfilzomib), or Arm C (receiving standard therapy combinations).

Before starting the main treatment, you will receive medications to prevent potential side effects.

These include paracetamol (pain reliever and fever reducer) taken by mouth or given through a vein, diphenhydramine hydrochloride (antihistamine to prevent allergic reactions) taken by mouth or given as injection, and dexamethasone (anti-inflammatory medication) given through a vein or taken by mouth.

You may also receive aciclovir tablets (200 mg) by mouth to prevent viral infections, and co-trimoxazole tablets (80/400 mg) by mouth to prevent certain bacterial infections.

If you are assigned to Arm A, you will receive linvoseltamab through a vein as an infusion.

The treatment will begin with a step-up dosing schedule, where the dose is gradually increased. Initial doses include 5 mg and 200 mg formulations given as concentrate for infusion.

The exact frequency and duration of infusions will be determined based on your response to treatment and tolerability.

If you are assigned to Arm B, you will receive a combination of linvoseltamab and carfilzomib.

Linvoseltamab will be given through a vein as an infusion, starting with a step-up dosing schedule using 5 mg and 200 mg formulations.

Carfilzomib will be given through a vein as an infusion, available in doses of 10 mg, 30 mg, or 60 mg as powder for solution.

Both medications will be administered according to a schedule determined by the study protocol.

If you are assigned to Arm C, you will receive standard therapy, which may include one of several combination regimens.

One possible combination includes daratumumab (1800 mg) given under the skin as injection, pomalidomide capsules (1 mg, 2 mg, 3 mg, or 4 mg) taken by mouth, and dexamethasone given through a vein or taken by mouth.

Another possible combination includes carfilzomib (10 mg, 30 mg, or 60 mg) given through a vein, dexamethasone given as infusion (4 mg/ml or 8 mg/2 ml formulations) or taken by mouth.

A third possible combination includes bortezomib (3.5 mg) given through a vein as injection, pomalidomide capsules taken by mouth, and dexamethasone.

The specific regimen and dosing schedule will be determined according to standard treatment protocols.

Treatment will continue in cycles. The length of each cycle and the number of cycles will depend on which treatment group you are assigned to and how your disease responds.

Throughout treatment, you will continue to receive preventive medications as needed to manage potential side effects.

Treatment will continue as long as your disease does not progress and you do not experience unacceptable side effects.

During the study, you will have regular visits for monitoring and assessments.

Blood samples will be collected to measure drug levels in your bloodstream and to check for minimal residual disease (very small amounts of cancer cells that may remain after treatment).

Your overall health status, physical functioning, and any side effects will be assessed regularly.

You will be asked to complete questionnaires about your quality of life, symptoms, and how treatment affects your daily activities.

At specific time points, particularly at 12 months, your response to treatment will be evaluated.

This includes checking whether you have achieved complete response (no detectable cancer), very good partial response, or partial response (cancer has decreased significantly).

Testing will also determine if you have achieved MRD-negative complete response, meaning no cancer can be detected even with very sensitive tests.

After completing the main treatment phase, you will continue to be followed for an extended period.

This follow-up will track your overall survival, time until disease progression, and time until you need to start a new treatment.

The study is expected to continue until 2034, though your individual participation duration may vary based on your treatment response and disease status.