ALB and anemia: While CTLA-4 expression was found to be associated with hypercalcemia, our observation of the PD-1 expression increasing with several other features of adverse clinical courses, such as advanced ISS stage, higher level of β2M, and decreased albumin levels and anemia, emphasizes a superior role of the PD-1 inhibitory receptor in the development of systemic immune suppression and myeloma progression.