Genetic features associated with LTS in MM. This schematic illustrates the evolution of MM from diagnosis through sustained MRD negativity to LTS (≥10 years), highlighting the genetic events that distinguish exceptional responders. Although disease progression often involves IgH translocations, chromosomal deletions (eg, del(13q14), del(17p)), and dysregulation of the cell cycle and oncogenic signaling, long-term survivors frequently exhibit more stable genomic profiles. Favorable features, such as hyperdiploidy and isolated t(11;14), which is associated with an indolent course and sensitivity to B-cell kymphoma 2 inhibition, are enriched in these patients, whereas high-risk lesions like t(4;14), gain(1q21), and del(17p) are typically absent. These intrinsic characteristics may contribute to reduced clonal evolution, sustained immune surveillance, and prolonged treatment-free remission. IgH, immunoglobulin H.