Our patient with sequential samples at SMM (SMM-1) and after progression to MM (MM-8) confirms the ability of RNA-sequencing to capture the cytogenetic phenotype even prior to iFISH; while this patient’s iFISH results were inconclusive in the sample taken during SMM, we were able to detect overexpression of ITGB7, MAFB, and CCND2 at the transcriptional level, suggesting a t(14;20) translocation, which was later confirmed by iFISH after the patient’s progression to MM. Here, ITGB7 is linked to Miyoshi myopathy.