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CD19-targeted chimeric antigen receptor T-cell therapy in patients with concurrent B-cell Non-Hodgkin lymphoma and rheumatic autoimmune diseases: a propensity score matching study

Bone Marrow Transplantation volume 58, pages 1223–1228 (2023)Cite this article

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Abstract

Rheumatic autoimmune diseases not only involve the production of autoantibodies but also demonstrate T-cell dysfunction. In patients with concurrent B-cell non-Hodgkin lymphoma (NHL) and rheumatic autoimmune diseases, the safety and efficacy of CD19-targeted chimeric antigen receptor (CAR) T-cell therapy are unknown. Using an aggregated electronic health record database, patients with rheumatic autoimmune diseases (auto group) were compared to propensity score-matched patients without rheumatic autoimmune diseases (non-auto group). From 1/2019 to 1/2023, 58 (4.3%) of 1,363 patients who received CD19-targeted CAR T-cell therapy had concurrent rheumatic autoimmune diseases. Both groups had similar incidence, severity, and management of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Moreover, the two groups had similar time-to-next treatment or death (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.60 to 1.59, log-rank p = 0.91) and overall survival (HR 0.90, 95%CI 0.46 to 1.78, p = 0.76). Following CAR T-cell infusion, patients with rheumatic autoimmune diseases achieved decreased inflammatory markers, seronegative conversion of autoantibodies, as well as reduced use of steroids and disease-modifying anti-rheumatic drugs. In conclusion, the safety and efficacy of CAR T-cell therapy were not affected in patients with rheumatic autoimmune diseases. Moreover, they achieved better biochemical control of underlying rheumatic diseases.

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Fig. 1: Time-to-next treatment or death (TNT-D) and overall survival (OS) after CD19-targeted CAR T-cell therapy.
Fig. 2: Cumulative incidence of anti-rheumatic medication resumption after CAR T-cell infusion.

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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Jiasheng Wang & Abdul Rahman Al Armashi

  2. Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Akram Alkrekshi, Srilatha Dasari, Hsin-Ti Cindy Lin & Dina Elantably

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  1. Jiasheng Wang
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Concept and design: JW, AA Data collection and analysis: JW Manuscript writing: All authors Final approval of manuscript: All authors.

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Correspondence to Jiasheng Wang.

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Wang, J., Alkrekshi, A., Dasari, S. et al. CD19-targeted chimeric antigen receptor T-cell therapy in patients with concurrent B-cell Non-Hodgkin lymphoma and rheumatic autoimmune diseases: a propensity score matching study. Bone Marrow Transplant 58, 1223–1228 (2023). https://doi.org/10.1038/s41409-023-02086-1

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