Clinical Research Directory

Inclusion Criteria: * Newly diagnosed symptomatic MM based on either standard CRAB criteria (at least 10% of clonal bone marrow plasma cells plus CRAB defined as the onset of any of the following clinical symptoms: hypercalcemia, renal failure, anemia and bone lesions) or at least 10% of bone marrow plasma cells plus the presence of at least one of the following biomarkers of malignancy: * 60% or greater clonal plasma cells on bone marrow examination; * Serum involved/uninvolved free light chain (FLC) ratio of 100 or greater; * More than one focal lesion on magnetic resonance imaging (MRI) that is at least 5 mm or greater in size. * Patient not eligible for ASCT (age ≥ 65 years or abnormal cardiac, pulmonary and liver function). * Patient defined as fit or intermediate according to the IMWG (International Myeloma Working Group) frailty score * Patient has given voluntary written informed consent. * Patient is able to be compliant with hospital visits and procedures required per protocol. * Patient agrees to use acceptable methods for contraception. * Patient has measurable disease according to IMWG criteria. * Patient has ECOG (Eastern Cooperative Oncology Group) performance status \< 3. * Pre-treatment clinical laboratory values within 30 days before randomization: * Platelet count ≥50 x 109/L (≥30 x 109 /L if myeloma involvement in the bone marrow is \> 50%) * Absolute neutrophil count (ANC) ≥ 1 x 109/L without the use of growth factors * Corrected serum calcium ≤14 mg/dL (3.5 mmol/L) * Alanine transaminase (ALT): ≤ 3 x the ULN * Total bilirubin: ≤ 2 x the ULN * Calculated or measured creatinine clearance: ≥ 30 mL/minute. * LVEF≥ 40%: 2-D transthoracic echocardiogram (ECHO) is the preferred method of evaluation; multigated Acquisition Scan (MUGA) is acceptable if ECHO is not available * Pre-treatment blood pressure value \< 140/90 mmHg even with adequate therapy: 24 hours blood pressure monitoring is the preferred method of evaluation; blood pressure diary at home for 2 weeks is acceptable. * Females of childbearing potential (FBCP) comply with the conditions of the Pregnancy Prevention Plan, including confirmation that she has an adequate level of understanding. * FBCP must follow the Pregnancy Prevention Plan and use a highly effective and an additional barrier contraception method simultaneously for 4 weeks before starting therapy, during treatment and dose interruptions and for at least 30 days after the last dose of study drugs\* * Males must use an effective barrier method of contraception if sexually active with FCBP during the treatment and for at least 90 days after the last administration of study drug/s. Male subjects must agree to refrain from sperm donation for at least 90 days after the last dose of carfilzomib. Exclusion Criteria: * Serious medical condition, laboratory abnormality or psychiatric illness that prevented the subject from the screening or place the subject at unacceptable risk. * Patient defined as frail according to the IMWG frailty score. * Previous treatment with anti-myeloma therapy (does not include radiotherapy, bisphosphonates, or a single short course of steroid \< to the equivalent of dexamethasone 40 mg/day for 4 days). * Pregnant or lactating females. * Presence of: * Clinical active infectious hepatitis type A, B, C or HIV * Acute active infection requiring antibiotics or infiltrative pulmonary disease * Pulmonary hypertension and interstitial lung disease * Uncontrolled arrhythmias or history of QT prolongation * Myocardial infarction or unstable angina ≤ 6 months or other clinically significant heart disease * Peripheral neuropathy or neuropathic pain grade 2 or higher, as defined by National Cancer Institute Common Toxicity Criteria (NCI CTC) 5.0 (Appendix A) * Uncontrolled hypertension defined as persistent hypertension (\>140/90 mmHg) regardless treatment with 3 drugs, including a diuretic. * Contraindication to any of the required drugs or supportive treatments and hypersensitivity to any excipient of the study drugs. * Known history of allergy to Captisol (a cyclodextrin derivative used to solubilize carfilzomib). * Invasive malignancy within the past 3 years. * Administration of any experimental drug within 4 weeks prior the baseline or within 5 drug half-lives.