In this discussion, Faith Davies, MBBCh, MRCP, MD, FRCPath, NYU Langone, New York City, NY, Gareth Morgan, MD, PhD, FRCP, FRCPath, NYU Langone Health, New York City, NY, Francesco Maura, MD, Memorial Sloan Kettering Cancer Center, New York, NY, discuss key themes from the session on defining high-risk multiple myeloma. The experts comment on the genomics of myeloma, the difference between genomic complexity and instability, and how exposure to BCMA-targeting agents may drive tumor escape. They also explore the mechanisms underlying genomic instability and the importance of detecting complexity early to prevent high-risk disease, as well as the roles of the immune system and the bone marrow microenvironment in its development. This discussion took place at the 3rd International Workshop on High-Risk Multiple Myeloma (iwHRMM 2026), held in Charleston, SC.
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