To provide more evidence that anti-CTLA-4 such as ipilimumab facilitates the depletion of Treg cells at the location of the tumor, metastatic biopsies obtained from 11 MM patients treated with ipilimumab showed a direct association between a high ratio of Teff to Treg and the occurrence of tumor necrosis [59]. The gene discussed is CTLA4; the disease is Miyoshi myopathy.