Irene Ghobrial, MD, from the Dana-Farber Cancer Institute, Boston, MA, chaired the session on ‘Advances in Disease Biology’ at the Controversies in Multiple Myeloma (COMy) 2019 World Congress in Paris, France. Dr Ghobrial shares insights from the session, particularly the need to better understand the mechanisms of clonal evolution in multiple myeloma and to be able to identify high-risk patients using techniques such as next-generation sequencing and cytogenetic sequencing.