In this study, we found several inhibitory immune checkpoints (TIGIT, CD96, BTLA, LAG3, KLRC1) upregulated in high-risk SMM patients, some of them being currently tested in clinical trials for patients with relapsed refractory MM, such as dual blockade of TIGIT and LAG-3 (NCT04150965). Here, LAG3 is linked to Miyoshi myopathy.