This activation triggers the release of various cytokines, chemokines, adipokines, and growth factors, such as interleukin (IL)-6, insulin-like growth factor 1 (IGF-1), vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNF-α), and stromal cell-derived factor 1 (SDF-1), which can initiate secondary genetic hits in genomically unstable MM clones, leading to myelomagenesis [8]. Here, IGF1 is linked to Miyoshi myopathy.