Abstract: Multiple myeloma (MM) is an incurable and malignant plasma cell tumor that has been shown to have significant variations in treatment responses and survival outcomes among patients. In recent years, advances in genomics, molecular biology, and immunology have greatly improved the ability to identify patients at different risk levels, thus laying the foundation for personalized treatment. As clinical and molecular markers continue to integrate, the risk stratification system for MM has evolved. However, current systems continue to face challenges in accurately identifying key molecular events, the impact of the bone marrow microenvironment, and tumor clonal evolution. In the context of novel immunotherapies and targeted therapies, advanced technologies are providing critical tools for developing more refined and multidimensional risk models. Therefore, conducting in-depth exploration and refinement of new stratified diagnostic systems is essential for improving the prognosis of MM patients and advancing precision diagnosis and treatment.