Dynamics of risk assessment in multiple myeloma. Considering all of the potential clinical and genomic risk factors, including but not limited to those in this figure, risk stratification at diagnosis should be considered a spectrum, with risk factors being additive rather than absolute. After initial stratification, risk should be reassessed based on the clinical course, with early relapse indicating a poor prognosis, regardless of initial risk considerations, and with recalibration of risk permitted by serial response assessment, with the most reliable indicator being MRD status. EMD, extramedullary disease.