While treating high risk patients it is critical to address complex biology & maximize the response for individual patients by gaining depth of response & maintaining that response for long duration. To ensure good quality of life patients should have good bone and kidney health. Treatment related side effects such as neuropathy need to be managed well. 3 or 4 drug regimens are commonly used in high-risk patients, 4 drug regimens increase the depth of response and induce MRD (Minimal Residual Disease) compared to 3 drug regimens. Intensification of treatment is important for sustaining good response. In high-risk patients who have not achieved MRD negativity or have achieved CR (complete response) transplantation can improve progression free survival.