The transition between MGUS, SMM, and MM (both intra- and extra-medullary) depends on reciprocal interactions contained in the bone marrow microenvironment, which are mediated by various cytokines (IL-6 and IGF1), adhesion molecules (MMSET), and cellular receptors (FGFR3) [3,4]. This evidence concerns the gene NSD2 and Miyoshi myopathy.