Thus, NOR area is directly associated with both nucleolar area and rRNA transcription.31 The clinical relevance of NORs in MM patients has been demonstrated by correlating increased NOR number in stage III MM compared to stage I.32 In addition, higher NOR counts in MM patients are directly associated with poorer survival.33 Together these data provide evidence that ACA11 overexpression drives a key nucleolar phenotype in MM associated with t(4;14) chromosomal translocation and poor outcomes. The gene discussed is SCARNA22; the disease is Miyoshi myopathy.