Notably, this analysis revealed that numerous genes critical to sphingolipid synthesis and metabolism to S1P were significantly elevated in myeloma, including serine palmitoyl transferase 1, 3-ketodihydrosphingosine reductase, ceramide synthases 2 and 5, sphingomyelinase 2, and alkaline ceramidase 3 (Figure 1A and Supplementary Figure 1), supporting the notion that sphingolipid metabolism is dysregulated in myeloma. This evidence concerns the gene ACER3 and plasma cell myeloma.