Safe pregnancy and delivery in a female patient with systemic lupus erythematosus after discontinuation of dual-target chimeric antigen receptor T cells therapy
10.19723/j.issn.1671-167X.2024.06.029
- VernacularTitle:双靶点嵌合抗原受体T细胞治疗系统性红斑狼疮患者停药后安全孕产1例
- Author:
Mingxia WANG
1
;
Ling DING
;
Min WANG
;
Chanjuan ZOU
;
Siyu YAN
;
Yingwen LIANG
;
Weijia WANG
;
Shanzhi HE
Author Information
1. 中山市人民医院风湿免疫科,广东中山 528403
- Publication Type:Journal Article
- Keywords:
Systemic lupus erythematosus;
Chimeric antigen receptor T cells;
Pregnancy and parturi-tion;
Antirheumatic agents
- From:
Journal of Peking University(Health Sciences)
2024;56(6):1119-1125
- CountryChina
- Language:Chinese
-
Abstract:
Systemic lupus erythematosus(SLE)is a diffuse,systemic autoimmune disorder that can impact multiple organs and systems,with patients exhibiting abnormal levels of various autoantibodies and immune markers in their serum.It is currently understood that dysregulation of B cells activation plays a pivotal role in the pathogenesis of SLE,as aberrantly activated B cells produce autoantibodies that inflict damage on multiple organs through complement activation and antibody-dependent cell-mediated cyto-toxicity.Traditional therapies for SLE may prove ineffective for certain patients or lead to adverse reactions.In most instances,conventional treatment merely alleviates symptoms and necessitates lifelong immuno-therapy.A limited number of clinical cases have explored chimeric antigen receptor T cells(CAR-T)therapy as a potential treatment for autoimmune diseases such as SLE.Research indicates that CAR-T can specifically target CD 19 expressed on the surface of B cells and plasma cells,achieving profound de-pletion while minimizing drug-related side effects.This report details a female patient diagnosed with SLE and lupus nephritis who was successfully treated using dual-targeting B cells maturation antigen CAR-T by our research team;following treatment,she ceased steroid and immunomodulator use,attaining sustained remission without these medications.The patient was a 23-year-old female.Multiple examinations in other hospitals and in our hospital showed positive anti-double-stranded DNA(dsDNA)antibody and low complement C3.Renal biopsy in our hospital showed lupus nephritis Ⅳ-G(A/C),and National Institu-tes of Health(NIH)activity index(AI)score=4.She was diagnosed with"SLE,lupus nephritis(LN)".She was treated with hormones,immunosuppressants and Chinese medicine,but the effect was not good.After the CAR-T treatment,She stopped using hormones and immune agents and achieved con-tinuous remission with zero hormones and zero immune agents.She became pregnant six months after CAR-T infusion,and gave birth to a healthy full-term,full-weight baby successfully.She is the first pa-tient in China who successfully discontinued hormone,immune preparations and gave birth after CAR-T therapy.During the follow-up of the patient,we found that the immune indexes had basically returned to normal,and the safety was good.It indicates that CAR-T therapy may represent a promising and innova-tive therapeutic approach for the management of SLE.This offers hope and establishes a precedent for SLE women of childbearing age.
