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Recent studies confirmed that daratumumab lacks the ability to induce apoptosis in the absence of crosslinking agents, though the contribution of direct cell death to overall anti-CD38 killing of MM cells in patients remains to be fully characterized [28]

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Further high-quality RCTs are warranted to refine dosing strategies and confirm long-term outcomes

Finally, the fourth mechanism entails target modification, which can occur through mutations, enzymatic alterations, and replacement 19,64,65