Journal Article

CD19 CAR T-Cell Therapy in Autoimmune Disease — A Case Series with Follow-up

Taubmann, Jule, Kharboutli, Soraya, Munoz, Luis, Tur, Carlo, Minopoulou, Ioanna, Schett, Georg, Mougiakakos, Dimitrios, Bucci, Laura, Knitza, Johannes, Wilhelm, Artur, Reimann, Hannah, Aigner, Michael, Mackensen, Andreas, Kretschmann, Sascha, Krönke, Gerhard, Vasova, Ingrid, Korganow, Anne-Sophie, Völkl, Simon, Winkler, Thomas, Bozec, Aline, Farge-Bancel, Dominique, Rothe, Tobias, Gerlach, Roman G., Bergmann, Christina, Müller, Fabian, Schäfer, Simon, Grieshaber-Bouyer, Ricardo, Spoerl, Silvia

2024

Overview

Treatment for autoimmune diseases such as systemic lupus erythematosus (SLE), idiopathic inflammatory myositis, and systemic sclerosis often involves long-term immune suppression. Resetting aberrant autoimmunity in these diseases through deep depletion of B cells is a potential strategy for achieving sustained drug-free remission. We evaluated 15 patients with severe SLE (8 patients), idiopathic inflammatory myositis (3 patients), or systemic sclerosis (4 patients) who received a single infusion of CD19 chimeric antigen receptor (CAR) T cells after preconditioning with fludarabine and cyclophosphamide. Efficacy up to 2 years after CAR T-cell infusion was assessed by means of Definition of Remission in SLE (DORIS) remission criteria, American College of Rheumatology-European League against Rheumatism (ACR-EULAR) major clinical response, and the score on the European Scleroderma Trials and Research Group (EUSTAR) activity index (with higher scores indicating greater disease activity), among others. Safety variables, including cytokine release syndrome and infections, were recorded. The median follow-up was 15 months (range, 4 to 29). The mean (±SD) duration of B-cell aplasia was 112±47 days. All the patients with SLE had DORIS remission, all the patients with idiopathic inflammatory myositis had an ACR-EULAR major clinical response, and all the patients with systemic sclerosis had a decrease in the score on the EUSTAR activity index. Immunosuppressive therapy was completely stopped in all the patients. Grade 1 cytokine release syndrome occurred in 10 patients. One patient each had grade 2 cytokine release syndrome, grade 1 immune effector cell-associated neurotoxicity syndrome, and pneumonia that resulted in hospitalization. In this case series, CD19 CAR T-cell transfer appeared to be feasible, safe, and efficacious in three different autoimmune diseases, providing rationale for further controlled clinical trials. (Funded by Deutsche Forschungsgemeinschaft and others.).

• Publisher: Massachusetts Medical Society
• Subject: Allergy / Antibodies / Antigens, CD19 - administration & dosage / Aplasia / Autoimmune Disease / Autoimmune diseases / Autoimmunity / CD19 antigen / Cell therapy / Cells / Chimeric antigen receptors / Clinical Medicine / Clinical Medicine General / Clinical trials / Critical Care / Cyclophosphamide / Cyclophosphamide - administration & dosage / Cytokine Release Syndrome - etiology / Cytokine storm / Cytokines / Dermatology / Dermatology General / Disease / Fludarabine / Follow-Up Studies / Genetics / Glomerular Disease / Hematology / Hospital-Based Clinical Medicine / Humans / Immunity / Immunology / Immunology General / Immunosuppressive agents / Immunotherapy, Adoptive / Infections - etiology / Inflammation / Inflammatory Disease / Interstitial Lung Disease / Kinases / Leukocytes / Lupus / Lupus Erythematosus, Systemic - therapy / Lymphocytes / Lymphocytes B / Lymphocytes T / Manufacturing / Myeloablative Agonists - administration & dosage / Myositis / Myositis - therapy / Nephrology / Neurotoxicity / Oncology / Oncology General / Outpatient-Based Clinical Medicine / Patients / Pulmonary / Remission / Remission (Medicine) / Rheumatoid Arthritis / Rheumatology / Rheumatology General / Scleroderma / Scleroderma, Systemic - therapy / Skin / Systemic lupus erythematosus / Systemic sclerosis / T-Cells / Treatment Outcome / Vasculitis