The explanation for this situation seems to be connected with the maturation stage of tumor cells, represented by the expression of CD19 and CD81 biomarkers, which is consistent with previous findings regarding the immune profile of tumor plasma cells:49 it suggests that early genetic alterations in the ontogeny of germinal-center B cells would provide a more aggressive profile in MM, which would be strong enough to overcome SHM and/or CSR earlier. This evidence concerns the gene CD19 and Miyoshi myopathy.