病例报告

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

  • 王明霞 ,
  • 丁菱 ,
  • 王敏 ,
  • 邹婵娟 ,
  • 颜丝语 ,
  • 梁颖文 ,
  • 王伟佳 ,
  • 何善智
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  • 1. 中山市人民医院风湿免疫科, 广东中山 528403
    2. 中山市人民医院先进诊断与先进治疗临床研究中心, 广东中山 528403

收稿日期: 2024-07-31

  网络出版日期: 2024-12-18

基金资助

中山市社会公益与基础研究项目(2023B1034);中山市卫生局医学科研项目(2021A020173)

版权

北京大学学报(医学版)编辑部, 2024, 版权所有,未经授权。

Safe pregnancy and delivery in a female patient with systemic lupus erythematosus after discontinuation of dual-target chimeric antigen receptor T cells therapy

  • Mingxia WANG ,
  • Ling DING ,
  • Min WANG ,
  • Chanjuan ZOU ,
  • Siyu YAN ,
  • Yingwen LIANG ,
  • Weijia WANG ,
  • Shanzhi HE
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  • 1. Department of Rheumatology and Immunology, Zhong-shan People' s Hospital, Zhongshan 528403, Guangdong, China
    2. Department of Advanced Diagnostic and Clinical Medicine, Zhong-shan People' s Hospital, Zhongshan 528403, Guangdong, China
HE Shanzhi, e-mail, zsccrhsz@aliyun.com

Received date: 2024-07-31

  Online published: 2024-12-18

Supported by

the Zhongshan Social Welfare and Basic Research Program(2023B1034);the Medical Research Project of Zhongshan Health Bureau(2021A020173)

Copyright

, 2024, All rights reserved, without authorization

本文引用格式

王明霞 , 丁菱 , 王敏 , 邹婵娟 , 颜丝语 , 梁颖文 , 王伟佳 , 何善智 . 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[J]. 北京大学学报(医学版), 2024 , 56(6) : 1119 -1125 . DOI: 10.19723/j.issn.1671-167X.2024.06.029

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 immunotherapy. 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 CD19 expressed on the surface of B cells and plasma cells, achieving profound depletion 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 Institutes 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 continuous 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 patient 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 innovative therapeutic approach for the management of SLE. This offers hope and establishes a precedent for SLE women of childbearing age.

参考文献

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