We previously showed that high levels of ST3Gal-6 gene expression were an independent risk factor for poor survival.47 We now report that within the CoMMpass study, 38.8% of patients have high RNA levels of either ST3Gal-6 or ST3Gal-4 along with high levels of FUT7, all of which are critical genes involved in E-selectin ligand synthesis.24, 48, 49, 50 Thus, it is likely that these patients would have increased E-selectin ligand expression with a higher percentage of Heca452-positive MM cells. Here, ST3GAL4 is linked to Miyoshi myopathy.