Moreover, secretion of immunoregulatory soluble factors from both MM and BM microenvironment cells including transforming growth factor TGF-β, interleukin IL-10, IL-6, prostaglandin E2, and APRIL; as well as adhesion of MM cells to extracellular matrix proteins and accessory cells further promotes immune evasion and inhibition of apoptosis (5). This evidence concerns the gene TNFSF13 and Miyoshi myopathy.