In vitro studies showed that pomalidomide is 10-fold more potent than lenalidomide in inhibiting TNFα; pomalidomide has distinct mechanisms of action compared with lenalidomide including direct anti-proliferative (by up-regulation the expression of p21 WAF1 tumor suppressor gene) and pro-apoptotic effects (by enhancing MM sensitivity to Fas-induced and TRAIL/Apo2L-induced apoptosis via a caspase-8-dependent mechanism) [22]. This evidence concerns the gene TNFSF10 and Miyoshi myopathy.