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In contrast, it would appear that the neurologic effects of cobalamin deficiency are due to metabolic disturbances unrelated to purine synthesis because the neurologic deficits may develop independently of the hematologic abnormalities, and folate supplementation will not prevent or reverse these deficits

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CD38, a multifunctional ectoenzyme highly expressed on malignant plasma cells, contributes to this niche by degrading nicotinamide adenine dinucleotide (NAD + ) into ADPR, which fuels adenosine (ADO) production through CD38/CD203a/CD73 enzymatic pathway