When examining individual markers of immune regulation, activation, and proliferation we observed that MM patients with high frequency of PD-1 (>median) on CD4eff (CD4 PD-1hi) had significantly shorter PFS (median 18 months vs 36 for those with low frequency of PD-1 (≤ median) on CD4eff, p=0.042) (Figure 2A). This evidence concerns the gene CD4 and Miyoshi myopathy.