Luciano Costa, MD, PhD, of the University of Alabama at Birmingham, Birmingham, AL, gives an overview of how high-risk multiple myeloma is defined and managed. Dr Costa also talks on the challenges faced when treating patients with high-risk multiple myeloma, as they often present with additional complications such as extramedullary disease, renal dysfunction, plasma cell leukemia, and high tumour burden, which are associated with poor clinical outcomes. Dr Costa goes on to describe how the evolving treatment landscape may impact the definition of high-risk multiple myeloma, highlighting findings from the MASTER study (NCT03224507), the FORTE trial (NCT02203643) and the IFM/DFCI2009 study (NCT01191060). This interview took place during the 18th International Myeloma Workshop (IMW 2021) congress.