The mechanisms of therapy resistance in multiple myeloma (MM) are evolving. This is deliberated in this insightful discussion between Marc Raab, MD, from the University of Heidelberg, Heidelberg, Germany, and Jonathan Keats, PhD, from the Translational Genomics Research Institute, Phoenix, AZ, at the Myeloma 2017 meeting in Edinburgh, UK. Dr Keats and Dr Rabb discuss the latest results of the CoMMpass study (NCT01454297). They question what confers resistance in patients, referencing the tumor microenvironment, as well as discussing novel subgroups of patients based on their genomic features.