• Relapsed or refractory multiple myeloma (MM) after at least 3 previous lines of therapy. Previous treatment must have included a proteasome inhibitor (bortezomib, ixazomib or carfilzomib), an immunomodulatory agent (thalidomide, lenalidomide or pomalidomide) and an anti cd38 monoclonal antibody.

• Histologically confirmed diagnosis of MM with measurable disease, as defined by the presence of monoclonal immunoglobulin protein in serum electrophoreses of at least 0.5 g/dL for immunoglobulin G (IgG) or 0.25 g/dL for IgA, or measurable light chain in serum (100 mg/L) or urinary excretion of at least 200 mg monoclonal light chain per 24 hours.

• No continuing acute toxic effects (except alopecia) of any prior chemotherapy, radiotherapy or surgical procedures. All such effects must have resolved to Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 grade =\< 1. Surgery (except minor procedures such as biopsies, intravenous \[IV\]-line placement, etc.) must have occurred at least 28 days prior to study enrollment.

• Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1. Evaluation of ECOG is to be performed within 7 days prior to the first dose of study intervention.

• Male or female \>= 18 years of age at the time of signing the informed consent form (ICF).

• Life expectancy of at least 3 months.

• Male/female participants who are at least 18 years of age on the day of signing informed consent with histologically confirmed diagnosis of relapse, refractory multiple myeloma will be enrolled in this study.

• A male participant must agree to use a contraception during the treatment period and for at least 7 months after the last dose of study treatment and refrain from donating sperm during this period.

• A female participant is eligible to participate if she is not pregnant, not breastfeeding, and at least one of the following conditions applies:

‣ Not a woman of childbearing potential (WOCBP) OR

⁃ A WOCBP who agrees to follow the contraceptive guidance in Appendix 3 during the treatment period and for at least 7 months after the last dose of study treatment.

• The participant (or legally acceptable representative if applicable) provides written informed consent for the trial, indicating that the patient is aware of the neoplastic nature of their disease and have been informed of the procedures of the protocol, the experimental nature of the therapy, possible alternative therapies, potential benefits, side effects, risks, and discomforts.

• Be willing and able to comply with scheduled visits, the treatment plan, and laboratory tests.

• Absolute neutrophil count (ANC) \>= 1000/uL (collected within 10 days prior to the start of study intervention).

• Platelets \>= 50,000/uL (collected within 10 days prior to the start of study intervention).

• Hemoglobin \>= 8.0 g/dL or \>= 5.0 mmol/L.

• Creatinine =\< 1.5 x upper limit of normal (ULN) or measured or calculated creatinine clearance (glomerular filtration rate \[GFR\] can also be used in place of creatinine or creatinine clearance (\[CrCl\]) \>= 30 mL/min for participant with creatinine levels \> 1.5 x institutional ULN (collected within 10 days prior to the start of study intervention).

• Total bilirubin =\< 1.5 x ULN OR direct bilirubin =\< ULN for participants with total bilirubin levels \> 1.5 x ULN (collected within 10 days prior to the start of study intervention).

• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase) \[SGOT\]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase) \[SGPT\]) =\< 2.5 x ULN (=\< 5 x ULN for participants with liver metastases) (collected within 10 days prior to the start of study intervention).

• International normalized ratio (INR) OR prothrombin time (PT) =\< 1.5 x ULN unless participant is receiving anticoagulant therapy as long as PT or activated partial thromboplastin time (aPTT) is within therapeutic range of intended use of anticoagulants (collected within 10 days prior to the start of study intervention).

• Activated partial thromboplastin time (aPTT) =\< 1.5 x ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of intended use of anticoagulants (collected within 10 days prior to the start of study intervention).

• Proteinuria normal or grade 1 based on 24-urine collection test. Patients with proteinuria \>= grade 2 due to light chains in the urine may be eligible based on review of screening urine electrophoresis results.

• Thyroid-stimulating hormone (TSH), thyroxine (T4) and adrenocorticotropic hormone (ACTH) within normal limits. Patients under treatment for hormonal abnormality(s) will be individually assessed for inclusion based on their history and current status.

• Criteria for known Hepatitis B and C positive subjects. Hepatitis B and C screening tests are not required unless:

‣ Known history of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection.

⁃ As mandated by local health authority.

• Hepatitis B positive subjects:

‣ Participants who are hepatitis B surface antigen (HBsAg) positive are eligible if they have received HBV antiviral therapy for at least 4 weeks and have undetectable HBV viral load prior to randomization.

⁃ Participants should remain on anti-viral therapy throughout study intervention and follow local guidelines for HBV anti-viral therapy post completion of study intervention.

• Participants with history of HCV infection are eligible if HCV viral load is undetectable at screening.

‣ Participants must have completed curative anti-viral therapy at least 4 weeks prior to randomization.