Primary Objective:

-To demonstrate the benefit of isatuximab in combination with bortezomib, lenalidomide, and dexamethasone in the prolongation of progression free survival (PFS) as compared to bortezomib, lenalidomide, and dexamethasone, in participants with newly diagnosed multiple myeloma (NDMM) not eligible for transplant.

Secondary Objectives:

• To evaluate in both randomized (isatuximab, bortezomib, lenalidomide and dexamethasone combination (IVRd) and bortezomib, lenalidomide and dexamethasone combination (VRd)) arms:
• Complete response (CR) rate, as defined by the International Myeloma Working Group (IMWG) criteria.
• Minimal residual disease (MRD) negativity rate in participants with CR.
• Very good partial response or better rate, as defined by the IMWG criteria.
• Overall survival (OS).
• To evaluate the overall response rate (ORR) as per IMWG criteria.
• To evaluate the time to progression (TTP) overall and by MRD status.
• To evaluate PFS by MRD status.
• To evaluate the duration of response (DOR) overall and by MRD status.
• To evaluate time to first response (TT1R).
• To evaluate time to best response (TTBR).
• To evaluate progression-free survival on next line of therapy (PFS2).
• To evaluate the sustained MRD negativity >12 months rate.
• To evaluate safety.
• To determine the pharmacokinetic (PK) profile of isatuximab in combination with bortezomib, lenalidomide, and dexamethasone (IVRd arm only).
• To evaluate the immunogenicity of isatuximab in participants receiving isatuximab (IVRd and crossover arms).
• To assess disease-specific and generic health-related quality of life (HRQL), disease and treatment-related symptoms, health state utility, and health status.

The duration of the study for each participant will include a screening period of up to 4 weeks, an induction period of 24 weeks (4 cycles with a duration of 42 ± 3 days), a continuous treatment period and a crossover period (when applicable). The cycle duration is 28 ± 3 days during the continuous treatment and crossover periods.

Inclusion Criteria:

Inclusion criteria :

• Multiple myeloma (IMWG criteria).
• Newly diagnosed multiple myeloma not eligible for transplant due to age (≥ 65 years) or participants < 65 years with comorbidities impacting possibility of transplant.
• Evidence of measurable disease.
• Written informed consent.

Exclusion criteria:

• Age < 18 years.
• Prior treatment for multiple myeloma.
• Any other prior or ongoing disease/health conditions incompatible with the study objectives.
• Organ function values not met.
• Eastern Cooperative Oncology Group (ECOG) Performance Status ( PS) > 2.
• Hypersensitivity to the study medications.
• Pregnant, breastfeeding, or woman of child bearing potential unwilling to use recommended contraception methods.
• Male participants who disagree to follow the study contraceptive counseling.

The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org