A Study Comparing AZD0120, a Dual-targeted CAR-T Against B-cell Maturation Antigen (BCMA) and CD19, Versus Standard Regimens in Participants With Relapsed Refractory Multiple Myeloma (DURGA-4)

Inclusion Criteria:

• Age ≥ 18 years

• Documented diagnosis of multiple myeloma according to the IMWG diagnostic criteria

• Documented evidence of measurable disease:

1. Serum M-protein level ≥ 1 g/dL

2. Urine M-protein level ≥ 200 mg/24h

3. Serum immunoglobulin free light chain ≥ 10 mg/dL (100 mg/L) and abnormal serumimmunoglobulin kappa lambda free light chain ratio

• Documented evidence of PD by IMWG 2016 criteria based on investigator'sdetermination during or after the most recent line of therapy. Participants withonly 1 prior line of therapy must have progressed within 47 months of a stem celltransplant, or if not transplanted, then within 42 months of starting initialtherapy

• Received 1 to 3 lines of prior therapy including an IMiD and either a PI or a CD38antibody. Participant must have undergone at least 2 complete cycles of treatmentfor each line of therapy, unless PD was the best response to the line of therapy

• Eligible to receive at least one of the standard regimens (DKd, PVd, DPd, or Kd) asdetermined by the Investigator.

• ECOG performance status score of 0 to 1

• Adequate hematology and chemistry laboratory values:

1. Haemoglobin ≥ 8.0 g/dL

2. Absolute neutrophil count ≥ 1 × 10^9/L (1000 per mm3)

3. Platelet count ≥ 75 × 10^9/L (75000 per mm3) in participants with < 50% of bonemarrow nucleated cells are plasma cells or ≥ 50 × 10^9/L (50000 per mm3) inparticipants with ≥ 50% of bone marrow nucleated cells are plasma cells

4. Absolute lymphocyte count ≥ 300/µL (0.3 × 109/L)

5. Total bilirubin ≤ 1.5 × ULN in the absence of Gilbert's syndrome or ≤ 3 × ULNif the participant has Gilbert's syndrome. AST and ALT≤ 3.0 × ULN. CrCl byCockcroft and Gault method ≥ 30 mL/minute

Exclusion Criteria:

• Known active, or prior history of CNS involvement or exhibits clinical signs ofmeningeal involvement of MM.

• Primary amyloidosis, active plasma cell leukaemia, Waldenstrom macroglobulinemia orPolyneuropathy Organomegaly Endocrinopathy M-protein and Skin (POEMS) syndrome.

• Participants with primary refractory MM (failed to generate at least a minimalresponse to any prior therapy)

• Significant neurological or psychiatric condition

• Significant medical condition that places the participant at an unacceptable riskfor treatment-related complications

• Previously received any prior BCMA-targeted treatment

• Previously received CAR-T or CAR-NK therapy directed at any target

• Previously received T-cell engager therapy directed at any target

• Previously received allogeneic stem cell transplantation at any time during priortherapy or received autologous stem cell transplantation within 12 weeks ofrandomization