Abstract: Multiple myeloma (MM) is an incurable malignant plasma cell tumor, with significant variation in treatment responses and survival outcomes among patients. 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 and making stratified diagnostic precision medicine the core strategy in MM therapy. As clinical and molecular markers continue to integrate, the risk stratification system for MM has evolved. However, current systems still 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, multidimensional risk models. Therefore, in-depth exploration and refinement of new stratified diagnostic systems are essential for improving the prognosis of MM patients and advancing precision diagnosis and treatment.