During progression from monoclonal gammopathy of undetermined significance (MGUS) and smoldering MM to active disease, these alterations vary from natural killer (NK) cell abundance in early stages and the loss of granzyme K+ memory cytotoxic T cells in smoldering MM [3] to an abundance of mesenchymal stromal cells with an inflammatory profile in active MM [4]. The gene discussed is GZMK; the disease is Miyoshi myopathy.