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It is known that reduction in CD38 expression on BM and circulating MM cells occurs rapidly after daratumumab initiation with significantly lower expression levels after the first infusion compared with baseline (potentially due to elimination of MM cells with high CD38 levels, endocytosis, or release in microvesicles), that may persist for at least 6 months after discontinuation [35]

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Furthermore, immune dysfunction leads to altered balance within the immune pathways resulting in excess inflammation