Carfilzomib, Daratumumab, Lenalidomide and Dexamethasone as First Line Treatment in Multiple Myeloma

Inclusion Criteria:

1. Patients with newly diagnosed and previously untreated multiple myeloma by theInternational Myeloma Working Group criteria that requires treatment based on:Presence of elevated calcium, renal failure, anemia and/or bone lesions (CRAB) Clonalbone marrow plasma cells ³ 60% Involved/uninvolved serum free light chain ratio ³ 100 >1 focal lesions on MRI studies (³5 mm in size)
2. Age > 18 years
3. Functional stage of 0 - 1 measured by the Eastern Cooperative Oncology Group (ECOG)scale.
4. Capacity and willingness to provide a written informed consent.

Exclusion Criteria:

1. POEMS syndrome
2. Systemic amyloidosis
3. Plasma cells leukemia
4. Radiotherapy on multiple sites on the period of 4 weeks before the initiation oftreatment (1 week if it is one region)
5. Improper liver function: total bilirubin > 1.5 x upper limit of normal (ULN) or > 3 xULN in patients with Gilbert syndrome, alanine aminotransferase (ALT) and aspartateaminotransferase (AST) > 3.0 x ULN.
6. Non-controlled systematic active infection (viral, bacterial and/or fungic).
7. Patients with known infection by human immunodeficiency virus (HIV).
8. Active infection by hepatitis B.
9. Active infection by hepatitis C.
10. Significant cardiovascular diseases as uncontrolled or symptomatic arrhythmias,congestive heart failure or acute myocardial infarction within 2 months prior toscreening, or any New York Heart Association (NYHA) class 3 or 4 heart disease.
11. Diagnosis of previous malignancies for 2 years, with exception of patients with basalor squamous cell carcinoma or "in situ" carcinoma of cervix or breast.
12. History of allergic reaction or severe anaphylaxis to humanized or murine monoclonalantibodies.
13. Pregnant or lactating women.