Nevertheless, the issue of the protective effect exerted by bone marrow mesenchymal stem cells (BMMSC) on the lytic activity of CD38-CAR in MM remains a challenge and reflects the need to generate high-affinity CAR constructs equipped with CD28/4-1BB co-stimulatory domains to preserve efficient CD38-CAR cytotoxic activity [90]. This evidence concerns the gene TNFRSF9 and Miyoshi myopathy.