Unfortunately, MM cells can develop several mechanisms of resistance to anti-CD-38 therapy, primarily CD38 down-regulation, depletion of NK cells via fratricide ADCC against nearby NK cells (as previously described), and immune escape of MM cells through the inhibition of ADCP by overexpression of the CD47 “don’t eat me” signal [134,135]. The gene discussed is CD38; the disease is Miyoshi myopathy.