Gareth Morgan, MD, PhD, FRCP, FRCPath, NYU Langone Medical Center, New York, NY, and Marc Raab, MD, of Heidelberg University Medical Center, Heidelberg, Germany, discuss recent advances in myeloma genomics. They highlight the various mutations seen in early and late phases of myeloma and the challenge of making successful therapies which harness the influence of epigenetics as well as the microbiome’s influence on myeloma. This roundtable was recorded at the International Myeloma Workshop (IMW) 2019, in Boston, MA.