Strikingly, 80% of melphalan-based high-dose chemotherapy-treated (a standard treatment at the time the study was conducted) patients with both low (below the median) Ubc9 and low PIAS1 were living 6 years after transplantation, whereas only 45% of patients with high expression survived 6 years, suggesting adverse effects of enhanced SUMOylation activity in MM patients. This evidence concerns the gene PIAS1 and Miyoshi myopathy.