Comparing Dara-VCD Chemotherapy Plus Stem Cell Transplant to Dara-VCD Chemotherapy Alone for People Who Have Newly Diagnosed AL Amyloidosis
Purpose
This phase III trial compares the effect of adding a stem cell transplant with melphalan after completing chemotherapy with daratumumab, cyclophosphamide, bortezomib and dexamethasone (Dara-VCD) versus chemotherapy with Dara-VCD alone for treating patients with newly diagnosed amyloid light chain (AL) amyloidosis. Melphalan is a chemotherapy given prior to a stem cell transplant. Giving chemotherapy before a peripheral blood stem cell transplant helps kill cancer cells in the body and helps make room in the patient's bone marrow for new blood-forming cells (stem cells) to grow. The stem cells are then returned to the patients to replace the blood forming cells that were destroyed by the chemotherapy. Daratumumab is in a class of medications called monoclonal antibodies. It binds to a protein called CD38, which is found on some types of immune cells and cancer cells, including myeloma cells. Daratumumab may block CD38 and help the immune system kill cancer cells. Chemotherapy drugs, such as cyclophosphamide and bortezomib, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Dexamethasone is in a class of medications called corticosteroids. It is used to lower the body's immune response to help stop the growth of cancer cells. Giving a stem cell transplant with melphalan after Dara-VCD may kill more cancer cells in patients with newly diagnosed AL amyloidosis.
Condition
- AL Amyloidosis
Eligibility
- Eligible Ages
- Over 18 Years
- Eligible Genders
- All
- Accepts Healthy Volunteers
- No
Criteria
Inclusion Criteria:
- STEP 1: Participants must have systemic AL amyloidosis which is biopsy proven and
includes histologically-confirmed by positive Congo red stain with green
birefringence on polarized light microscopy, OR characteristic appearance by
electron microscopy AND confirmatory AL amyloid typing (mass spectrometry-based
proteomic analysis or immunofluorescence). If there is question regarding diagnosis,
consult study chairs prior to registration
- STEP 1: Participants must have measurable disease within 28 days prior to treatment
if initiated prior to registration or within 28 days of registration as defined by
at least one of the following:
- Positive monoclonal serum immunofixation electrophoresis
- Positive monoclonal urine immunofixation electrophoresis
- Monoclonal plasma cells in bone marrow In addition, participants must also have
a difference between the involved and uninvolved free light chain (dFLC) >= 2
mg/dL
- STEP 1: Participants may receive up to one cycle (or 28 days) of therapy prior to
enrollment. If a patient receives >= 75% of 1 cycle of protocol identical Dara-VCD,
this will be considered 1 cycle of protocol induction. Any patient who receives less
than 75% of 1 cycle of Dara-VCD or non-protocol therapy will still be eligible but
will be treated per protocol. If protocol identical therapy is initiated prior to
enrollment, this treatment is not continued but rather treatment is dictated per
protocol
- STEP 1: Participants may be receiving chronic corticosteroids if they are being
given for disorders other than AL amyloidosis or myeloma
- STEP 1: Participant must be >= 18 years old
- STEP 1: Participant must have Eastern Cooperative Oncology Group (ECOG) performance
score (PS) of 0, 1, or 2 (PS = 3 may be allowed if secondary to neuropathy)
- STEP 1: Participant must have a complete medical history and physical exam within 28
DAYS prior to registration
- STEP 1: Participants must be willing to undergo high dose chemotherapy and
autologous stem cell transplantation if they are randomized to the arm receiving
high dose chemotherapy and autologous stem cell transplantation
- STEP 1: Participants must be eligible to receive high dose chemotherapy with
melphalan at a dose of 200 mg/m^2 or 140 mg/m^2 (200 mg/m^2 is highly encouraged but
not mandated). Transplant eligibility criteria are included in the general
eligibility criteria listed below:
- Participant must have a supine systolic blood pressure (BP) >= 90 mmHg (at
registration step-1, this may by supported by midodrine
- Participant must have non-severe cardiac AL (meeting all the below criteria) as
defined by:
- N-terminal proB-type natriuretic peptide (NT proBNP) < 5000 (if no
NTproBNP, brain natriuretic peptide [BNP] must be available and < 400)
- Troponin T (TnT) < 0.06. If not available, one of the following two
criteria must be met:
- High sensitivity troponin (hsTnT) T < 75 or troponin I < 0.1ng/dL
- New York Heart Association (NYHA) I or II
- Cardiac ejection fraction (EF) >= 40%
- STEP 1: Hemoglobin >= 8.0 g/dL (> 5 mmol/L); red blood cell transfusion allowed up
to 7 day prior to registration (within 28 days prior to registration) (NOTE: Growth
factor support granulocyte colony-stimulating factor [G-CSF] is permitted per
institutional guidelines)
- STEP 1: Leukocytes >= 2 x 10^3/uL (within 28 days prior to registration) (NOTE:
Growth factor support [G-CSF] is permitted per institutional guidelines)
- STEP 1: Absolute neutrophil count >= 1.0 x 10^3/uL (within 28 days prior to
registration) (NOTE: Growth factor support [G-CSF] is permitted per institutional
guidelines)
- STEP 1: Platelets >= 50 x 10^3/uL (within 28 days prior to registration) (NOTE:
Growth factor support [G-CSF] is permitted per institutional guidelines)
- STEP 1: Total bilirubin =< 1.5 times the institutional upper limit of normal (ULN)
unless history of Gilbert's disease. Participants with history of Gilbert's disease
must have total bilirubin =< 5 x institutional ULN (within 28 days prior to
registration)
- STEP 1: Direct bilirubin =< 2.0 mg/dL (within 28 days prior to registration)
- STEP 1: Aspartate aminotransferase (AST)/ alanine aminotransferase (ALT) =< 3x upper
limit of normal (ULN) (except if secondary to hepatic involvement) (within 28 days
prior to registration)
- STEP 1: Alkaline phosphatase =< 750 U/L (except if secondary to hepatic involvement)
(within 28 days prior to registration)
- STEP 1: Participants must have a serum creatinine =< the institutional (I)ULN OR
measured OR calculated creatinine clearance >= 30 mL/min using the following
Cockcroft-Gault formula. This specimen must have been drawn and processed within 28
days prior to registration
- STEP 1: If peripheral neuropathy is present at diagnosis, participants must be grade
2 (moderate symptoms; limiting instrumental activity of daily living [ADL]) or less
- STEP 1: Participants must have adequate cardiac function. Participants with known
history or current symptoms of cardiac disease, or history of treatment with
cardiotoxic agents, must have a clinical risk assessment of cardiac function using
the New York Heart Association Functional Classification. To be eligible for this
trial, participants must be class 2 or better
- STEP 1: Participants must not be seropositive for hepatitis B (defined by a positive
test for hepatitis B surface antigen [HBsAg]). Subjects with resolved infection
(i.e., subjects who are HBsAg negative but positive for antibodies to hepatitis B
core antigen [anti-HBc] and/or antibodies to hepatitis B surface antigen [anti-HBs])
must be screened using real-time polymerase chain reaction (PCR) measurement of
hepatitis B virus (HBV) deoxyribonucleic acid (DNA) levels. Those who are PCR
positive will be excluded. EXCEPTION: Subjects with serologic findings suggestive of
HBV vaccination (anti-HBs positivity as the only serologic marker) AND a known
history of prior HBV vaccination, do not need to be tested for HBV DNA by PCR
- STEP 1: Participants with a history of hepatitis C virus (HCV) infection must have
been treated and cured. Participants currently being treated for HCV infection must
have undetectable HCV viral load test on the most recent test results obtained
within 6 months prior to registration, if indicated
- STEP 1: Participants must not have concurrent multiple myeloma as defined by the
presence of lytic bone disease, plasmacytomas, >= 60% plasma cells in the bone
marrow, or hypercalcemia. Participants will not be excluded solely based on the
presence of plasma cells > 10% in the bone marrow unless the plasma cell percentage
exceeds >60%
- STEP 1: Participants must not have known allergies to any of the study drugs
- STEP 1: Participants must not have had a major surgery within 14 days prior to
registration and be fully recovered from surgery completed within 14 days prior to
registration
- STEP 1: Participants must not have a known chronic obstructive pulmonary disease
with a forced expiratory volume in 1 second (FEV1) < 50% of predicted normal
- STEP 1: Participants with known human immunodeficiency virus (HIV)-infection must be
on effective anti-retroviral therapy at registration and have undetectable viral
load test on the most recent test results obtained within 6 months prior to
registration
- STEP 1: Participants must not have either moderate or severe persistent asthma
within the past 2 years), or currently have uncontrolled asthma of any
classification. (Note that subjects who currently have controlled intermittent
asthma or controlled mild persistent asthma are allowed in the study)
- STEP 1: Participants must not have uncontrolled diabetes within 28 days prior to
registration
- STEP 1: Participants must not have uncontrolled blood pressure and hypertension
within 14 days prior to registration. Participants must have a supine systolic BP of
>= 90 mmHg
- STEP 1: Participants must not have a prior or concurrent malignancy whose natural
history or treatment (in the opinion of the treating physician) has the potential to
interfere with the safety or efficacy assessment of the investigational regimen
- STEP 1: Participants must not have received vaccination with live attenuated
vaccines within 28 days prior to Registration to Step 1
- STEP 1: Participants must not have uncontrolled infection at the discretion of the
enrolling physician and to be discussed with the study chair if the participant is
on active anti-infectious therapy. Any patient on active anti-microbial therapy for
chronic infectious issues should be discussed with the study chair prior to
enrollment
- STEP 1: Participants must not be pregnant or nursing (nursing includes breast milk
fed to an infant by any means, including from the breast, milk expressed by hand, or
pumped). Individuals who are of reproductive potential must have agreed to use an
effective contraceptive method with details provided as a part of the consent
process. A person who has had menses at any time in the preceding 12 consecutive
months or who has semen likely to contain sperm is considered to be of "reproductive
potential." In addition to routine contraceptive methods, "effective contraception"
also includes refraining from sexual activity that might result in pregnancy and
surgery intended to prevent pregnancy (or with a side-effect of pregnancy
prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal
ligation/occlusion, and vasectomy with testing showing no sperm in the semen
- STEP 1: Participants must be offered the opportunity to participate in specimen
banking. With participant consent, specimens must be collected and submitted via the
Southwestern Oncology group (SWOG) Specimen Tracking System
- STEP 1: Participants must agree to have blood, bone marrow core biopsy and aspirate,
and fat pad biopsy specimens submitted for minimal residual disease assessment and
future exploratory studies
- STEP 1: Participants who can complete PRO, QOL, PRO-CTCAE questionnaires, etc. forms
in English, Spanish and French must participate in the patient-reported outcomes and
quality of life
- STEP 2: Participants must have met all eligibility criteria for Step-1 registration
- STEP 2: Participants must have achieved at least a partial response
- STEP 2: Participants must continue receiving at least one of study drugs
(bortezomib, cyclophosphamide, or daratumumab and hyaluronidase-fihj) if another
study drug (daratumumab and hyaluronidase-fihj, cyclophosphamide, or bortezomib) has
been discontinued due to adverse events. Note: daratumumab and hyaluronidase-fihj
cannot be permanently discontinued
- STEP 2: Participants must have completed induction therapy
- STEP 2: Participants must be registered to Step 2 within 42 days of cycle 3, day 28
of induction therapy
- STEP 2: Participants must plan to initiate their assigned consolidation therapy
within 8 weeks after randomization
- STEP 2: Participants must not have experienced a MOD-PFS event
- STEP 2: Participants must have ECOG performance score (PS) of 0, 1, or 2 (PS = 3 may
be allowed if secondary to neuropathy)
- STEP 2: Participant must have a complete medical history and physical exam within 28
days prior to registration
- STEP 2: Participants must be willing to undergo high dose chemotherapy and
autologous stem cell transplantation if they are randomized to the arm receiving
high dose chemotherapy and autologous stem cell transplantation
- STEP 2: Participants randomized to Arm 2 must be willing and able to return to a
participating treatment center for their assigned treatment after transplant. Note
that participants need not to have a direct relationship with the transplant center
in order to register
- STEP 2: Participants must be eligible to receive high dose chemotherapy with
melphalan at a dose of 200 mg/m^2 or 140 mg/m^2 (200 mg/m^2 is highly encouraged but
not mandated). Transplant eligibility criteria are included in the general
eligibility criteria listed below:
- Patient must have a supine systolic BP >= 90 mmHg (at registration step-1, this
may not by supported by midodrine)
- Patient must have non-severe cardiac AL as defined by:
- NT proBNP <5000 (if no NTproBNP, BNP must be available and < 400 pg/mL)
(within 14 days prior to registration step-2)
- TnT < 0.06. If not available, one of the following two criteria must be
met (within 14 days prior to registration step-2)
- hsTnT <75 or troponin I < 0.1ng/dL
- NYHA I or II (within 14 days prior to registration step-2)
- Cardiac EF >= 40% (within 14 days prior to registration step-2)
- STEP 2: Hemoglobin > 8.0 g/dL (> 5 mmol/L); red blood cell transfusion allowed up to
7 days prior to registration (within 28 days prior to registration) (NOTE: Growth
factor support [G-CSF] is permitted per institutional guidelines)
- STEP 2: Leukocytes >= 2 x 10^3/uL (within 28 days prior to registration) (NOTE:
Growth factor support [G-CSF] is permitted per institutional guidelines)
- STEP 2: Absolute neutrophil count >= 1.0 x 10^3/uL (within 28 days prior to
registration) (NOTE: Growth factor support [G-CSF] is permitted per institutional
guidelines)
- STEP 2: Platelets >= 50 x 10^3/uL (within 28 days prior to registration) (NOTE:
Growth factor support [G-CSF] is permitted per institutional guidelines)
- STEP 2: Total bilirubin =< 1.5 times the institutional ULN unless history of
Gilbert's disease. Participants with history of Gilbert's disease must have total
bilirubin =< 5 x institutional ULN (within 28 days prior to registration)
- STEP 2: Direct bilirubin =< 2.0 mg/dL (except if secondary to hepatic involvement)
(within 28 days prior to registration)
- STEP 2: AST/ALT =< 3x upper limit of normal (ULN) (except if secondary to hepatic
involvement) (within 28 days prior to registration)
- STEP 2: Alkaline phosphatase =< 750 U/L (except if secondary to hepatic involvement)
(within 28 days prior to registration)
- STEP 2: Participants must have a serum creatinine =< the IULN OR calculated
creatinine clearance ≥ 30 mL/min using the following Cockcroft-Gault Formula. This
specimen must have been drawn and processed within 28 days prior to registration
- STEP 2: Participants must not have uncontrolled infection at the discretion of the
enrolling physician and to be discussed with the study chair if the participant is
on active anti-infectious therapy. Any patient on active anti-microbial therapy for
chronic infectious issues should be discussed with the study chair prior to
enrollment
- STEP 2: Participants randomized to the ASCT arm must be able to have at least 2.0 x
10^6 CD34 cells/kg collected
- STEP 2: Participants who can complete PRO, QOL, PRO-CTCAE questionnaires, etc. forms
in English, Spanish and French must participate in the patient-reported outcomes and
quality of life
- STEP 3: Participants must have met all eligibility criteria for Step-1 and Step-2
registration
- STEP 3: Participants must not have had daratumumab and hyaluronidase-fihj
permanently discontinued during induction or consolidation
- STEP 3: Participants must have completed induction and consolidation therapy
- STEP 3: Participants must be registered to Step 3 within the following time frames:
- If randomized to Arm 1 Dara-VCD consolidation: within 28 days of completion of
3 cycles of consolidation therapy
- If randomized to Arm 2 high dose chemotherapy and autologous stem cell
transplantation: within 180 days following initiation of stem cell
transplantation
- STEP 3: Participants must not have experienced a MOD-PFS event
- STEP 3: Participants must have ECOG performance score (PS) of 0, 1, or 2 (PS = 3 is
allowed if secondary to neuropathy)
- STEP 3: Participants must have a complete medical history and physical exam within
28 DAYS prior to registration
- STEP 3: Hemoglobin > 8.0 g/dL (> 5 mmol/L); red blood cell transfusion allowed up to
7 days prior to registration (within 28 days prior to registration) (NOTE: Growth
factor support [G-CSF] is permitted per institutional guidelines)
- STEP 3: Leukocytes >= 2 x 10^3/uL (within 28 days prior to registration) (NOTE:
Growth factor support [G-CSF] is permitted per institutional guidelines)
- STEP 3: Absolute neutrophil count >= 1.0 x 10^3/uL (within 28 days prior to
registration) (NOTE: Growth factor support [G-CSF] is permitted per institutional
guidelines)
- STEP 3: Platelets >= 50 x 10^3/uL (within 28 days prior to registration) (NOTE:
Growth factor support [G-CSF] is permitted per institutional guidelines)
- STEP 3: Total bilirubin =< 1.5 times the institutional upper limit of normal (ULN)
unless history of Gilbert's disease. Participants with history of Gilbert's disease
must have total bilirubin =< 5 x institutional ULN (within 28 days prior to
registration)
- STEP 3: Direct bilirubin =< 2.0 mg/dL (within 28 days prior to registration)
- STEP 3: AST/ALT =< 3x upper limit of normal (ULN) (except if secondary to hepatic
involvement) (within 28 days prior to registration)
- STEP 3: Alkaline phosphatase =< 750 U/L (except if secondary to hepatic involvement)
(within 28 days prior to registration)
- STEP 3: Participants must not have uncontrolled infection at the discretion of the
enrolling physician and to be discussed with the study chair if the participant is
on active anti-infectious therapy. Any patient on active anti-microbial therapy for
chronic infectious issues should be discussed with the study chair prior to
enrollment
- Participants must be informed of the investigational nature of this study and must
sign and give informed consent in accordance with institutional and federal
guidelines.
For participants with impaired decision-making capabilities, legally authorized
representatives may sign and give informed consent on behalf of study participants in
accordance with applicable federal, local, and Central Institutional Review Board (CIRB)
regulations
Study Design
- Phase
- Phase 3
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Sequential Assignment
- Primary Purpose
- Treatment
- Masking
- None (Open Label)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Active Comparator Consolidation Arm I (Chemotherapy) |
Patients receive daratumumab and hyaluronidase-fihj SC over 3-5 minutes on days 1 and 15 as well as bortezomib SC over 3-5 minutes, cyclophosphamide PO or IV, and dexamethasone PO or IV on days 1, 8, 15 and 22 of each cycle. Cycles repeat every 28 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography at screening and at progression. Patients undergo bone marrow aspiration and biopsy within14-28 days post consolidation treatment and at progression. Patients undergo blood and urine sample collection at screening, at the start of each cycle, and the end of treatment and during follow up or at progression. |
|
|
Experimental Consolidation Arm II (Chemotherapy, ASCT) |
Patients undergo collection of peripheral blood stem cells. Patients receive melphalan IV for 1 cycle and then 2 days later receive the stem cell transplant IV in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography at screening and at progression. Patients undergo bone marrow aspiration and biopsy within 60-90 days post initiation of stem cell transplant. Patients undergo blood and urine sample collection at screening, during treatment, and the end of treatment and during follow up or at progression. |
|
|
Experimental Induction (Chemotherapy) |
Patients receive daratumumab and hyaluronidase-fihj SC over 3-5 minutes on days 1, 8, 15 and 22 for 2 cycles and then days 1 and 15 for cycle 3. Patients receive bortezomib SC over 3-5 minutes, cyclophosphamide PO or IV, and dexamethasone PO or IV on days 1, 8, 15 and 22 of each cycle. Cycles repeat every 28 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo CT, MRI or PET-CT and fat pad aspiration at screening. Patients undergo echocardiography at screening, the completion of induction, and at progression. Patients undergo bone marrow aspiration and biopsy at screening, post induction treatment and at progression. Patients undergo blood and urine sample collection at screening, at the start of each cycle, and the end of treatment and during follow up or at progression. |
|
|
Experimental Maintenance (daratumumab and hyaluronidase-fihj) |
Patients receive maintenance daratumumab and hyaluronidase-fihj SC over 3-5 minutes on day 1 of each cycle. Cycles repeat every 28 days for up 18 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography at screening, 12 months post consolidation treatment and at progression. Patients undergo bone marrow aspiration and biopsy 12 months post consolidation treatment and at progression. Patients undergo blood and urine sample collection at screening, during treatment, 12 months post consolidation treatment and during follow up or at progression. |
|
Recruiting Locations
Boston, Massachusetts 02118
Site Public Contact
617-638-8265
More Details
- Status
- Recruiting
- Sponsor
- SWOG Cancer Research Network
Study Contact
Detailed Description
PRIMARY OBJECTIVE: I. To compare major organ deterioration progression-free survival between participants randomized to the autologous stem cell transplant (ASCT) and non-ASCT arms of this study. SECONDARY OBJECTIVES: I. To compare overall survival (OS) between participants randomized to the ASCT and non-ASCT arms of this study. II. To compare rates of cardiac and renal organ responses between participants randomized to the ASCT and non-ASCT arms of this study. III. To compare rates of cardiac and renal organ progression between participants randomized to the ASCT and non-ASCT arms of the study. IV. To compare the frequency and severity of toxicities between participants randomized to the ASCT and non-ASCT arms of this study. V. To compare minimal residual disease (MRD) negativity rates between participants randomized to the ASCT and non-ACST arms of this study. ADDITIONAL OBJECTIVES: I. To compare the best overall hematologic response rates between participants randomized to the ASCT and non-ASCT arms of this study. II. To compare rates of hematologic complete response (CR) and very good partial response, following completion of consolidation therapy between participants randomized to the ASCT and non-ASCT arms of this study, post-consolidation. III. To compare hematologic progression-free survival between participants randomized to the ASCT and non-ASCT arms of this study. IV. To compare time to next treatment between participants randomized to the ASCT and non-ASCT arms of the study. V. To evaluate utilization of delayed ASCT in participants randomized to the non-ASCT arm of the study. TRANSLATIONAL MEDICINE PRIMARY OBJECTIVES: I. To compare MRD negativity rates from bone marrow aspirates via next generation flow cytometry (NGF) between the ASCT and non-ASCT arms of this study post-consolidation. II. To bank specimens for future use. TRANSLATIONAL MEDICINE EXPLORATORY OBJECTIVES: I. To evaluate MRD negativity rates at post-induction, and compare MRD negativity rates at 12 months post-consolidation from bone marrow aspirates via NGF between participants randomized to the ASCT and non-ASCT arms of this study. II. To investigate the association of achieving MRD negativity at any point (post-induction, post-consolidation, or 12 months post-consolidation) via NGF from bone marrow aspirates with major organ deterioration-progression free survival (MOD-PFS). III. To investigate the association of achieving sustained MRD negativity (MRD negative at two consecutive measurements -- post-induction, post-consolidation, and 12 months post-consolidation) via NGF from bone marrow aspirates with MOD-PFS. QUALITY OF LIFE (QOL) PRIMARY OBJECTIVE: I. To compare patient-reported physical function following consolidation treatment between participants randomized to the ASCT and non-ASCT arms using the Patient Reported Outcomes Measurement Information System (PROMIS)-29+2 Profile version (v) 2.1 physical function sub-scale. QOL SECONDARY OBJECTIVES: I. To compare patient-reported fatigue following consolidation treatment between participants randomized to the ASCT and non-ASCT arms using the PROMIS-29 fatigue subscale. II. To compare longitudinal changes in physical function using the PROMS-29+2 between participants randomized to the ASCT and non-ASCT arms. QOL EXPLORATORY OBJECTIVES: I. To assess baseline symptom burden in AL amyloidosis patients prior to induction therapy using the PROMIS-29+2. II. To compare mean scores of symptom scales using the PROMIS-29+2 following consolidation treatment, and at 6 months and 12 months from step 3 registration between treatment arms. III. To compare mean scores of functional scales using the PROMIS-29+2, following consolidation treatment, and at 6 months and 12 months from step 3 registration between treatment arms. IV. To explore whether longitudinal changes in symptoms, functioning, and overall heath related quality of life (HRQoL) as assessed by the PROMIS-29 +2 (version 2.1) differ according to treatment group and, separately, according to baseline cardiac or renal involvement using interaction tests between participants randomized to the ASCT and non-ASCT arms. V. To compare health utility indices using the PROMIS preference score (PROPr) between patients randomized to the ASCT and non-ASCT arms. PATIENT REPORTED OUTCOME (PRO)-COMMON TERMINOLOGY CRITERIA FOR ADVERSE EVENTS (CTCAE) PRIMARY OBJECTIVE: I. To compare patient reported symptoms regarding treatment emergent adverse events of interest using the Patient Reported Outcome CTCAE (PRO-CTCAE) Measurement System between patients randomized to the ASCT and non-ASCT arms of this study. OUTLINE: INDUCTION: Patients receive daratumumab and hyaluronidase-fihj subcutaneously (SC) over 3-5 minutes on days 1, 8, 15 and 22 for 2 cycles and then days 1 and 15 for cycle 3. Patients receive bortezomib SC over 3-5 minutes, cyclophosphamide orally (PO) or intravenously (IV), and dexamethasone PO or IV on days 1, 8, 15 and 22 of each cycle. Cycles repeat every 28 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET)-CT and fat pad aspiration at screening. Patients undergo echocardiography at screening, the completion of induction, and at progression. Patients undergo bone marrow aspiration and biopsy at screening, post induction treatment and at progression. Patients undergo blood and urine sample collection at screening, at the start of each cycle, and the end of treatment and during follow up or at progression. CONSOLIDATION: Patients who achieve an overall response of partial response or better after 3 cycles of Dara-VCD are randomized to 1 of 2 arms. ARM I: Patients receive daratumumab and hyaluronidase-fihj SC over 3-5 minutes on days 1 and 15 as well as bortezomib SC over 3-5 minutes, cyclophosphamide PO or IV, and dexamethasone PO or IV on days 1, 8, 15 and 22 of each cycle. Cycles repeat every 28 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography at screening and at progression. Patients undergo bone marrow aspiration and biopsy within14-28 days post consolidation treatment and at progression. Patients undergo blood and urine sample collection at screening, at the start of each cycle, and the end of treatment and during follow up or at progression. ARM II: Patients undergo collection of peripheral blood stem cells. Patients receive melphalan IV for 1 cycle and then 2 days later receive the stem cell transplant IV in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography at screening and at progression. Patients undergo bone marrow aspiration and biopsy within 60-90 days post initiation of stem cell transplant. Patients undergo blood and urine sample collection at screening, during treatment, and the end of treatment and during follow up or at progression. MAINTENANCE: Patients receive maintenance daratumumab and hyaluronidase-fihj SC over 3-5 minutes on day 1 of each cycle. Cycles repeat every 28 days for up 18 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography at screening, 12 months post consolidation treatment and at progression. Patients undergo bone marrow aspiration and biopsy 12 months post consolidation treatment and at progression. Patients undergo blood and urine sample collection at screening, during treatment, 12 months post consolidation treatment and during follow up or at progression. After completion of study treatment, patients are followed up every 3 or 6 months up to 4 years after registration.