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Methods: This study investigates (i) the enzymatic functions of CD38, (ii) the in vitro effects of DARA and ISA on CD38_mediated NAD + degradation in primary MM cells and a representative MM cell line, and (iii) the in vivo dynamics of ADO and its metabolite inosine (INO) in BM and peripheral blood (PB) plasma from MM patients receiving DARA monotherapy