For KYDAR clinical trial patients or primary refractory MM (PRMM) patients, this study established a unique MM resistance pattern including stimulation of proteasome machinery (PSMB4 and PSMA2), mitochondrial stress (COX6C, COX7A2), ER and UPR pathway (PPIA, STMN1), as well as downregulation of PC checkpoint genes. This evidence concerns the gene COX6C and Miyoshi myopathy.