Lenalidomide inhibits VEGF-induced PI3K-Akt pathway signaling and HIF-1α expression [32], exerts an anti-tumor necrosis factor alpha (TNFα) activity, modulates the immune response stimulating T cells and NK cells activities, induces apoptosis of tumor cells, and decreases the binding of MM cells to BMSCs [30,33,34,35,36]. Here, TNF is linked to Miyoshi myopathy.