In MM patients with advanced-stage disease, T-cell signaling (CD28, CD152, CD3zeta, p56lck, ZAP-70, PI3-k) was impaired and its intracellular cytokine expression (IL-γ, IL-2, IL-4) was downregulated in CD4+ and CD8+ T cells [96], and PD-1+CD8+ T cells from the bone marrow of MM patients co-expressed other immune checkpoint inhibitory receptors such as RAG3 and TIGIT. Here, CTLA4 is linked to Miyoshi myopathy.