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In a recent report, MM cells from patients who discontinued treatment with daratumumab, due to disease progression, appeared to retain cell-surface expression of CD38 [33]

But the real problem is degraded medication

These new codes that were effective July 1, 2025, were assigned to comment indicator NP in Addendum B to the CY 2026 OPPS/ASC proposed rule to indicate that the codes are assigned to an interim APC assignment and comments would be accepted on their interim APC assignments

Metformin, a first-line diabetes medication, interferes with B12 absorption in the terminal ileum through mechanisms involving calcium-dependent membrane action and bacterial overgrowth

QJM: Monthly Journal of the Association of Physicians

Biochemically, the cobalt center can take part in both two-electron and one-electron reductive processes to access the "reduced" (B 12r , +2 oxidation state) and "super-reduced" (B 12s , +1 oxidation state) forms