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We report results on long-term OS and subsequent antimyeloma therapies from the MAIA final analysis. A protocol amendment (July 20, 2021) led to a long-term extension of MAIA, during which patients were followed for OS. A total of 737 patients were randomized to D-Rd (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009368) or Rd (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009369). At a median follow-up of 89.3\u00a0months (range, 0.0\u2013102.2; interquartile range, 85.3\u201393.0), median OS was 90.3 months (95% confidence interval [CI], 80.8\u2013not estimable [NE]) with D-Rd versus 64.1 months (56.0\u201370.8) with Rd (hazard ratio [HR], 0.67; 95% CI, 0.55\u20130.82); estimated 7-year OS rates were 53.1% (95% CI, 47.8\u201358.2) and 39.3% (34.1\u201344.5), respectively. Median time to subsequent antimyeloma treatment was not reached (95% CI, 84.1\u2013NE) for D-Rd versus 42.4 months (33.5\u201350.6) for Rd (HR, 0.51; 95% CI, 0.41\u20130.63;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.0001). Death due to adverse events occurred in 84 patients (D-Rd,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200944\/364 [12%]; Rd,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200940\/365 [11%]). With &gt;7 years of follow-up, D-Rd demonstrated a new benchmark for median OS (7.5 years) in transplant-ineligible NDMM, further supporting frontline D-Rd use to maximize survival.\n                  <\/jats:p>","DOI":"10.1038\/s41375-026-03097-9","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:02:48Z","timestamp":1787569368000},"page":"2530-2539","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Daratumumab, lenalidomide, and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: MAIA final survival analysis"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7705-8460","authenticated-orcid":false,"given":"Thierry","family":"Facon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5392-9284","authenticated-orcid":false,"given":"Shaji 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Leukemia. 2025;39:710\u20139.","journal-title":"Leukemia"}],"container-title":["Leukemia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41375-026-03097-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41375-026-03097-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41375-026-03097-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:58:49Z","timestamp":1793105929000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41375-026-03097-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":34,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["3097"],"URL":"https:\/\/doi.org\/10.1038\/s41375-026-03097-9","relation":{},"ISSN":["0887-6924","1476-5551"],"issn-type":[{"value":"0887-6924","type":"print"},{"value":"1476-5551","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"assertion":[{"value":"18 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 July 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"TF has nothing to disclose. SKK received research funding from AbbVie, Amgen, AstraZeneca, Bristol Myers Squibb, CARsgen, Janssen, Molecular Templates, Novartis, Roche-Genentech, Takeda, and TeneoBio; and consulted for or participated on an advisory board for AbbVie, Amgen, Antengene, AstraZeneca, BeiGene, bluebird bio, Bristol Myers Squibb, Epizyme, Janssen, Oncopeptides, Roche-Genentech, Secura Bio, and Takeda. RZO received support for the present manuscript from Janssen; received laboratory research funding from Asylia Therapeutics, Biotheryx, and Heidelberg Pharma; received clinical research funding from CARsgen, Celgene, Exelixis, Janssen Biotech, Sanofi-Aventis, and Takeda; received royalties or licenses for, has patents planned, issued, or pending for, and holds stock or stock options in Asylia Therapeutics; received consulting fees from EcoR1 Capital; and participated on an advisory board for Amgen, Biotheryx, Bristol Myers Squibb, Celgene, Forma Therapeutics, Genzyme, GSK Biologicals, Ionis, Janssen Biotech, Juno Therapeutics, Karyopharm, Kite, Neoleukin, Oncopeptides, Regeneron, Sanofi-Aventis, Servier, and Takeda. NB received research funding from Celgene, Janssen, and Pfizer; participated on an independent review committee for Janssen, Karyopharm, and Legend Biotech; received honoraria for educational events from Bristol Myers Squibb, Celgene, and Janssen; and participated on an advisory board for AbbVie, Amgen, Bristol Myers Squibb, Celgene, Genentech, GSK, Janssen, Karyopharm, Pfizer, Sanofi, and Takeda. PM served on advisory boards for and received honoraria from AbbVie, Amgen, Bristol Myers Squibb, Janssen, Pfizer, Sanofi, and Takeda. HG received grants or contracts from Bristol Myers Squibb, Celgene, Dietmar Hopp Foundation, Janssen, and Sanofi; received consulting fees from Bristol Myers Squibb, GSK, Janssen, and Sanofi; received payment or honoraria for lectures and presentations from Amgen, Bristol Myers Squibb, GSK, Janssen, and Sanofi; received support for attending meetings or travel, or both, from Amgen, Bristol Myers Squibb, GSK, Janssen, Pfizer, and Sanofi; and received research support from Amgen, Bristol Myers Squibb, Celgene, GSK, GlycoMimetics Inc., Heidelberg Pharma, Hoffmann-La Roche, Janssen, Millennium, Novartis, Oncopeptides, Pfizer, and Sanofi. SB has no competing interests to declare. CH received honoraria from AbbVie, Amgen, Bristol Myers Squibb, Janssen, and Pfizer. SZ received research support from Janssen and Takeda and served on advisory boards for Amgen, Bristol Myers Squibb, Janssen, Oncopeptides, Sanofi, and Takeda. KW served in an advisory role or provided expert testimony for AbbVie, Adaptive Biotechnologies, Amgen, AstraZeneca, BeiGene, Bristol Myers Squibb, CellCentric, GSK, Janssen, Karyopharm, Oncopeptides, Pfizer, Regeneron, Roche, Sanofi, Stemline, and Takeda; received honoraria from AbbVie, Adaptive Biotechnologies, Amgen, AstraZeneca, BeiGene, Bristol Myers Squibb, GSK, Janssen, Karyopharm, Novartis, Oncopeptides, Pfizer, Regeneron, Roche, Sanofi, Stemline, and Takeda; and received grants from AbbVie (to the institution), Amgen (to the institution), Bristol Myers Squibb\/Celgene (to the institution), GSK (to the institution), Janssen (to the institution), and Sanofi (to the institution). AP served in a consulting or advisory role for AbbVie, Amgen, Bristol Myers Squibb, Janssen, Pfizer, and Sanofi; and received research funding from Bristol Myers Squibb, Sanofi, and Takeda. CJ served as a member of a board or advisory committee for Amgen and GSK. NR served in an advisory role for Amgen, bluebird bio, Caribou, GSK, and Immuneel. SM received grant support, paid to Institut pour la Recherche sur le Cancer de Lille, from AbbVie; received grant support and advisory board fees, paid to Institut pour la Recherche sur le Cancer de Lille, from Amgen and Celgene; and received grant support, advisory board fees, paid to Journ\u00e9es d\u2019H\u00e9matologie Clinique Lilloises, and travel support from Janssen Biotech. AC served in a consulting role or on an advisory board for AbbVie, Amgen, Antengene, Bristol Myers Squibb\/Celgene, Genentech, GSK, Janssen, Karyopharm, Millennium\/Takeda, Sanofi, Seattle Genetics, Secura Bio, and Shattuck Labs; and received research funding from Amgen, Bristol Myers Squibb\/Celgene, Janssen, Millennium\/Takeda, and Seattle Genetics. MH received honoraria from Bristol Myers Squibb, Celgene, and Janssen. M Mohty received honoraria from Adaptive Biotechnologies, Amgen, Bristol Myers Squibb, Celgene, Janssen, Novartis, Sanofi, and Takeda; and received research funding from Celgene, Janssen, and Sanofi. MD received honoraria from and served in a consulting or advisory role for Amgen, Bristol Myers Squibb, Janssen, Sanofi, and Stemline; and received research funding from Janssen. TP received consulting fees from Celgene. GC received research support from Bristol Myers Squibb\/Celgene, Janssen, and Takeda; and served as a consultant for and received honoraria from Amgen, Bristol Myers Squibb\/Celgene, GSK, Janssen, Millennium\/Takeda, Oncopeptides, Roche, and Sanofi. XL has no competing interests to declare. HQ received grants or contracts from AbbVie, Antegene, Bristol Myers Squibb, GSK, Karyopharm, and Sanofi; and had a leadership or fiduciary role in advisory boards for AbbVie, Antengene, Bristol Myers Squibb, GSK, Johnson & Johnson, Pfizer, and Sanofi. CPV received honoraria from Amgen, Bristol Myers Squibb, GSK, Janssen, Pfizer, Sanofi, and Takeda. MT has no competing interests to declare. M Macro received honoraria from and served in a consulting or advisory role for Bristol Myers Squibb\/Celgene, Janssen, Sanofi, and Takeda; received research funding from Janssen and Takeda; and received travel, accommodations, or expenses from Janssen and Sanofi. LF received support for attending meetings or travel, or both, from Amgen and Janssen; and received payment or honoraria for educational events from Amgen, Bristol Myers Squibb, Celgene, Janssen, Sanofi, and Takeda. GW is an employee of and holds stock in Johnson & Johnson. HP is an employee of and holds stock in Johnson & Johnson. KB has a direct financial relationship with Amgen, Bristol Myers Squibb, Johnson & Johnson, Pfizer, and Sanofi. RC is an employee of Johnson & Johnson. FB is an employee of and holds stock in Johnson & Johnson. SZU received grants from Amgen, Bristol Myers Squibb, Celgene, GSK, Janssen, Merck, Pharmacyclics, Sanofi, Seattle Genetics, SkylineDx, and Takeda; and received personal fees from AbbVie, Amgen, Celgene, Genentech, Gilead, GSK, Janssen, Merck, Mundipharma, Oncopeptides, Sanofi, Seattle Genetics, SkylineDx, and Takeda.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}}]}}