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In this discussion, experts Kenneth Anderson, MD, Dana-Farber Cancer Institute, Boston, MA, Francesco Maura, MD, Memorial Sloan Kettering Cancer Center, New York, NY, and Mehmet Samur, PhD, Dana-Farber Cancer Institute, Boston, MA, explore how the definition of high-risk multiple myeloma is evolving in the era of immune-based therapies. They first highlight progress made over the past two decades, emphasizing the need for refined risk models that integrate genomic, microenvironmental, and treatment-related factors. They also discuss emerging data on mechanisms of resistance to monoclonal antibodies such as daratumumab, the importance of patient profiling to guide therapy selection, and future strategies to optimize use of the expanding treatment arsenal. This discussion took place at the 2nd International Workshop on High-Risk Multiple Myeloma (iwHRMM 2025), held in Charleston, SC. These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.