We agree with the points made by Drs Amer and Leung: optimal induction immunosuppression for patients receiving daratumumab is not known, over immunosuppression is best avoided in myeloma patients due to increased risk of infection, and selection of immunosuppression for unique sub-populations is best guided by rigorous protocols in large populations.1 We acknowledge that our case neither proves that daratumumab caused acute cellular rejection (ACR), nor does it mandate the use of lymphocyte depletion for patients receiving daratumumab prior to kidney transplantation.