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These abnormalities are associated with aggressive disease, frequent relapses, and inferior progression\u2010free and overall survival. This review explores the evolving therapeutic landscape for high\u2010risk MM, focusing on induction strategies for both transplant\u2010eligible and transplant\u2010ineligible patients, the role of autologous stem cell transplantation (ASCT), and the use of consolidation and maintenance therapies. Emerging modalities such as bispecific antibodies and chimeric antigen receptor T\u2010cell (CAR\u2010T) therapies are examined, particularly in the context of their integration into earlier lines of treatment. Quadruplet induction regimens incorporating proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies have shown promise in improving outcomes and are becoming a cornerstone of frontline therapy. The review also emphasizes the potential of personalized, risk\u2010adapted approaches based on cytogenetic profiling and minimal residual disease (MRD) monitoring. 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