This paper examines the current state of multiple myeloma (MM) treatment in the United States, comparing clinical practice and clinical trials with Japan. The differences in healthcare systems between the two countries impact treatment approaches and access, with the US primarily using private insurance while Japan employs universal healthcare coverage. In the US, NCCN guidelines are widely used and linked to insurance reimbursement. The multidisciplinary team approach, especially the utilization of nurse practitioners (NPs), differs significantly from Japan. Access to specialists in the US is relatively easy, with advanced electronic medical record systems facilitating information sharing. For initial treatment, four-drug combinations such as Dara-VRd have become standard, while CAR-T therapy and bispecific antibody therapies are expanding for relapsed/refractory MM. Physician-initiated clinical trials are particularly active in the US. The exchange between Japan and the US provides valuable opportunities to gain international perspectives on MM management.