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The prognosis for multiple myeloma is based on clinical, biological and, above all, cytogenetic criteria. Advances in next-generation sequencing (NGS) have made it possible to refine risk stratification by identifying major genetic abnormalities and their combinations. Following R-ISS and its revisions, an international consensus (Consensus Genomic Staging, 2025) now defines high-risk myelomas by incorporating deletions, translocations, mutations and biochemical markers. These tools reinforce the predictive value of risk, but the prognosis remains modulated by therapeutic response and residual disease, paving the way for precision medicine.