We performed a comprehensive review with meta- and network meta-analyzes of maintenance-therapy studies. Lenalidomide, proteasome inhibitors, and CD38 antibodies improved progression-free survival (PFS). However, overall survival (OS) benefit appeared only with lenalidomide in transplant-eligible (TE) patients, while CD38-directed therapy showed a trend toward improved OS not seen with proteasome inhibitors. The network meta-analysis ranked regimens against observation: daratumumab–lenalidomide (DR) yielded the greatest PFS benefit, followed by carfilzomib–lenalidomide–dexamethasone (KRd), KR in TE, and DRd in transplant-ineligible patients. Significant OS prolongation in TE patients occurred with KR, DR, and lenalidomide alone.
