The authors explain that the efficacy of CAR-T cells depends on antigen engagement and T cell activation, leading to the destruction of target cells. However, high-level target engagement leads to intense CAR-T cell activation, resulting in cytokine release syndrome (CRS) and immune-related effector cell neurotoxicity syndrome (ICANS)—acute events commonly occurring in B cell malignancies.
In the example case, CRS and ICANS did not occur. The authors note that data from previously treated patients with SLE show no major CRS or ICANS, likely based on a lower target cell engagement of CAR-T cells, with fewer B cells in SLE than in B cell malignancies.
“The low-level acute toxicity of CAR-T cell treatment, such as CRS, and the possibility to be off further immunosuppressive drugs provides a new option for safe and long-term remission, especially in young women with SLE,” the authors conclude. At nine months after CAR-T cell administration, the case patient is “still in drug-free remission, being off glucocorticoids, hydroxychloroquine and all other immunosuppressants.”
Katie Robinson is a medical writer based in New York.
References
- Bucala R, Solomon DH. Immunology for the rheumatologist: A&R introduces a new problembased immunology review series with great educational potential. Arthritis Rheumatol. 2024 Jan;76(1):9–10.
- Taubmann J, Müller F, Yalcin-Mutlu M, et al. CD19 chimeric antigen receptor T cell treatment: Unraveling the role of B cells in systemic lupus erythematosus. Arthritis Rheumatol. 2024 Apr;76(4):497–504.
