Importantly, it has also shown that IMiDs downregulate not only c-Myc, but also IRF4,3, 8 which has a central role in MM pathogenesis.6 These studies show that IMiDs inhibit multiple key molecules that mediate MM cell proliferation, survival and drug resistance in the context of the bone marrow (BM) microenvironment. This evidence concerns the gene IRF4 and Miyoshi myopathy.