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CD38 is not only a surface marker but also a tightly regulated ectoenzyme expressed in two isoforms ( + to nicotinamide (NAM) and ADP-ribose (ADPR), supporting Ca 2+ influx, proliferation, and mitochondrial stability ( 2+ signaling ( CD38 expression persists across all MM stages, likely reflecting its metabolic and immunoregulatory roles ( + , and cGAMP, that may promote immune tolerance ( Figure 1 )

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Conversely, medications that further slow gastric emptying, such as anticholinergics or opioid analgesics, may exacerbate gastrointestinal adverse effects including nausea, vomiting, and constipation

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