In a case like this you can use the ~T directive:
(format nil "~2&~4T~A~%~6T#~%~4Telse~%~6T#~%~4Tend" (fourth e))
If the amount of indentation is determined at runtime, you can use ~VT:
(format nil "~VT~a" 5 "test")
=> " test"
Note that ~xT means "move to position x from the start of the line", not
"insert x spaces", that's why I said that this works in the example you
provided, ie to indent strings from the left margin.
Also, instead of (concatenate 'string r (format nil "...")) I would add
a ~a at the beginning of the format string, and simply use
(format nil "~a..." r other-arguments...)
Alberto