However, prior attempts to assess the biologic differences between the primary CD138 + MM cells from NDMM based on the presence or absence of elevated serum LDH levels using transcriptomics only detected the overexpression of proteolytic and cell adhesion signatures, evasion/suppression of host immune system, hyper-proliferative signatures via cell division and RTK pathways in the primary CD138 + MM cells from patients with elevated serum LDH levels [12]. This evidence concerns the gene SDC1 and Miyoshi myopathy.