Comparison of the safety profiles of CD19-targeting CAR T-cell therapy in patients with SLE and B-cell lymphoma

Müller F, Schwingen NR, Hagen M, Scholz J, Aigner M, Wirsching A, Taubmann J, Kretschmann S, Kharboutli S, Krickau T, Naumann-Bartsch N, Benintende G, Spörl S, Rothe T, Bruns H, Grieshaber-Bouyer R, Metzler M, Blumenthal DB, Graw F, Schett G, Mackensen A, Völkl S (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Blood American Society of Hematology

DOI: 10.1182/blood.2025028375

Abstract

CD19-directed chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of relapsed/refractory B-cell non-Hodgkin lymphoma (B-NHL) and recently showed effects in autoimmune diseases, such as systemic lupus erythematosus (SLE). Despite high levels of inflammation, toxicity seemed to differ between patients with SLE and B-NHL. We therefore compared the CAR T-cell kinetics and treatment-related side effects to better define the toxicity profiles. In contrast with the similar CAR T-cell expansion, patients with SLE revealed a lower incidence and severity of cytokine-release syndrome, immune effector cell–associated neurotoxicity syndrome, and immune effector cell–associated hematotoxicity. Although the neutrophil nadir was lower in patients with SLE after therapy, the platelet counts remained close to normal and hematotoxicity was shorter in SLE than B-NHL. The reduced hematotoxicity correlated with lower acute-phase inflammation, better hematologic reserve before CAR T-cell therapy, and distinct serum cytokine profiles. Interestingly, CAR T-cell persistence was consistently shorter, and the reconstitution of conventional T and B cells was faster in SLE. In both cohorts, B-cell reconstitution correlated with functional CD4+ T-cell recovery, indicating a general biologic process of hematopoietic and immune system regeneration. In summary, similar lymphodepletion and CAR T-cell pharmacokinetics led to distinct toxicity, demonstrating that CAR T-cell therapy had a favorable side-effect profile in SLE, including faster recovery of the adaptive immune system.

Authors with CRIS profile

Fabian Müller Department of Medicine 5 – Haematology and Oncology Nora Rebecca Schwingen Department of Medicine 5 – Haematology and Oncology Melanie Hagen Department of Medicine 3 – Rheumatology and Immunology Julia Scholz Department of Medicine 5 – Haematology and Oncology Jule Taubmann Department of Medicine 3 – Rheumatology and Immunology Giulia Benintende Department of Medicine 5 – Haematology and Oncology Silvia Spörl Department of Medicine 5 – Haematology and Oncology Tobias Rothe Department of Medicine 3 – Rheumatology and Immunology Heiko Bruns Department of Medicine 5 – Haematology and Oncology David Blumenthal Professur für Biomedical Network Science Frederik Graw Professur für Modellierung von Immunprozessen Georg Schett Lehrstuhl für Innere Medizin III Andreas Mackensen Lehrstuhl für Innere Medizin V Simon Völkl Department of Medicine 5 – Haematology and Oncology

Involved external institutions

Bayerisches Zentrum für Krebsforschung (BZKF) DE Germany (DE)

How to cite

APA:

Müller, F., Schwingen, N.R., Hagen, M., Scholz, J., Aigner, M., Wirsching, A.,... Völkl, S. (2025). Comparison of the safety profiles of CD19-targeting CAR T-cell therapy in patients with SLE and B-cell lymphoma. Blood. https://doi.org/10.1182/blood.2025028375

MLA:

Müller, Fabian, et al. "Comparison of the safety profiles of CD19-targeting CAR T-cell therapy in patients with SLE and B-cell lymphoma." Blood (2025).

BibTeX: Download