Gareth Morgan, MD, PhD, FRCP, FRCPath, NYU Langone Orthopedic Center, New York, NY, talks on the focuses of debates to be discussed at the COMy 2021 roundtable session on ‘High-risk disease biology’. A major talking point will be the appropriate number of risk strata. Given recent trial success in improving outcomes for conventionally defined high-risk patients, recognizing an ‘ultra-high-risk’ group may be important to improve outcomes in very difficult to treat patients. The roundtable debate will aim to set out definitions of high-risk disease, and discuss how it should be recognized and optimally treated. This interview took place during the 7th World Congress on Controversies in Multiple Myeloma (COMy), 2021.