MM TME is characterized by the presence of several immunosuppressive cellular and non-cellular elements including myeloid-derived suppressor cells (MDSCs), tumor-associated M2-like macrophages, regulatory T-cells, and tumor promoting and immunomodulatory factors such as IL-6, TGF-β, IL-10, PGE2 [48]. This evidence concerns the gene TGFB1 and Miyoshi myopathy.