Maintenance treatment draws out progression-free endurance (PFS) in patients with recently analyzed different myeloma (NDMM) not going through autologous stem cell transplantation (ASCT) is limited to immunomodulatory agents. Randomly assigned (3:2) patients with NDMM who are not undergoing ASCT and had achieved better than partial response after a period of 6-12 months of standard induction therapy were included for this study. The primary endpoint was PFS since time of randomization. The results obtained showed,Common any-grade TEAEs included nausea (26.8% v 8.0%), vomiting (24.2% v 4.3%), and diarrhea (23.2% v 12.3%). TOURMALINE-MM4 met its primary endpoint with a 34.1% reduction in risk of progression or death with ixazomib versus placebo (median PFS since randomization, 17.4 v 9.4 months; hazard ratio [HR], 0.659; 95% CI, 0.542 to 0.801; P < .001; median follow-up, 21.1 months). There was no increase in new primary malignancies (5.2% v 6.2%); rates of on-study deaths were 2.6% versus 2.2%. As a conclusion it is evident that, Ixazomib maintenance prolongs PFS with no unexpected toxicity in patients with NDMM not undergoing ASCT.