This finding and data published by others11,27,28 suggest that gain of 1q21 should be included in the HR category in patients exposed to ixazomib plus thalidomide-dexamethasone, and probably in all other studies investigating the impact of cytogenetics.26 The frequency of 1q21 gains increases with progressing disease.29 Several genes located in this region, such as PSMD4,30 CKS1B31 MUC1, MCL, ILF2 and others have been associated with increased myeloma progression and likely account for the poorer outcome of patients with gain within this gene region. The gene discussed is PSMD4; the disease is plasma cell myeloma.