CASC3 and Miyoshi myopathy: In case of BTZ resistance, adaptation mechanisms include alterations at the level of the proteosome (mutations in the proteosome binding pocket, reduction of the 19S proteosome subunit, up-regulation of proteasomal machinery), upregulation of heat-shock proteins, genetic changes, activation of the aggresome-autophagy pathway, interactions within the MM tumor microenvironment (TME) and metabolic alterations (6, 8, 12, 13).