Chimeric Antigen Receptor T-cell therapy (CAR-T), currently employed routinely for treating B-cell malignancies, has emerged as a groundbreaking approach in addressing severe autoimmune diseases, especially for systemic lupus erythematosus (SLE). The immunological rationale for targeting B lymphocytes in autoimmune diseases is well-established, demonstrating success in numerous autoantibody-mediated autoimmune conditions through targeted therapies over several years. However, this approach has often proven ineffective in the context of systemic lupus erythematosus. Recent data on CAR-T usage in lupus, revealed promising results including rapid and prolonged remission without treatment, highlighting the potential of CAR-T therapy in severe lupus cases. This article provides a comprehensive overview of CAR-T cells, tracing their evolution from hematological malignancies to their recent applications in autoimmune disorder, especially in lupus. Clinical trials within a regulated framework are now imperative to assess the procedural aspects in order to validate the considerable promise of CAR-T cell therapy in the field of autoimmune diseases. This includes evaluating safety and long-term efficacy and security of the procedure, the benefit-risk ratio in the field of autoimmunity, the availability and cost-related issues associated with this emerging cellular therapy procedure.

2024-09-01·Annals of Neurology

The Role of Chimeric Antigen Receptor T‐Cell Therapy in Immune‐Mediated Neurological Diseases

Review

作者: Snowden, John A ; Sharrack, Basil ; Brittain, Gavin ; Greco, Raffaella ; Roldan, Elisa ; Alexander, Tobias ; Saccardi, Riccardo

Despite the use of ‘high efficacy’ disease‐modifying therapies, disease activity and clinical progression of different immune‐mediated neurological diseases continue for some patients, resulting in accumulating disability, deteriorating social and mental health, and high economic cost to patients and society. Although autologous hematopoietic stem cell transplant is an effective treatment modality, it is an intensive chemotherapy‐based therapy with a range of short‐ and long‐term side‐effects. Chimeric antigen receptor T‐cell therapy (CAR‐T) has revolutionized the treatment of B‐cell and other hematological malignancies, conferring long‐term remission for otherwise refractory diseases. However, the toxicity of this treatment, particularly cytokine release syndrome and immune effector cell‐associated neurotoxicity syndrome, and the complexity of production necessitate the need for a high level of specialization at treating centers. Early‐phase trials of CAR‐T therapies in immune‐mediated B cell driven conditions, such as systemic lupus erythematosus, neuromyelitis optica spectrum disorder and myasthenia gravis, have shown dramatic clinical response with few adverse events. Based on the common physiopathology, CAR‐T therapy in other immune‐mediated neurological disease, including multiple sclerosis, chronic inflammatory polyradiculopathy, autoimmune encephalitis, and stiff person syndrome, might be an effective option for patients, avoiding the need for long‐term immunosuppressant medications. It may prove to be a more selective immunoablative approach than autologous hematopoietic stem cell transplant, with potentially increased efficacy and lower adverse events. In this review, we present the state of the art and future directions of the use of CAR‐T in such conditions. ANN NEUROL 2024;96:441–452

2024-09-01·Transplantation and Cellular Therapy

Clinical Practice Recommendations for Hematopoietic Cell Transplantation and Cellular Therapies in Follicular Lymphoma: A Collaborative Effort on Behalf of the American Society for Transplantation and Cellular Therapy and the European Society for Blood and Marrow Transplantation

Review

作者: Oluwole, Olalekan O ; Kamdar, Manali ; Salles, Gilles ; Chavez, Julio ; Smith, Sonali M ; Sauter, Craig S ; Iqbal, Madiha ; Bachanova, Veronika ; Kuruvilla, John ; Maziarz, Richard T ; Hamadani, Mehdi ; Hamad, Nada ; Casulo, Carla ; Kahl, Brad S ; Advani, Ranjana ; Montoto, Silvia ; Flowers, Christopher ; Kanate, Abraham S ; Sureda, Anna M ; Cohen, Jonathon ; Shadman, Mazyar ; Kharfan-Dabaja, Mohamed A ; Dreyling, Martin ; Dreger, Peter ; Glass, Bertram ; Budde, Lihua Elizabeth ; Jacobson, Caron ; Kumar, Ambuj

Follicular lymphoma (FL) is the most common indolent B-cell non-Hodgkin lymphoma (NHL), accounting for nearly one-third of all NHL. The therapeutic landscape for patients with FL has significantly expanded over the past decade, but the disease continues to be considered incurable. Hematopoietic cell transplantation (HCT) is potentially curative in some cases. Recently, the emergence of chimeric antigen receptor T-cell therapy (CAR-T) for patients with relapsed/refractory (R/R) FL has yielded impressive response rates and long-term remissions, but definitive statement on the curative potential of CAR-T is currently not possible due to limited patient numbers and relatively short follow up. A consensus on the contemporary role, optimal timing, and sequencing of HCT (autologous or allogeneic) and cellular therapies in FL is needed. As a result, the American Society of Transplantation and Cellular Therapy (ASTCT) Committee on Practice Guidelines endorsed this effort to formulate consensus recommendations to address this unmet need. The RAND-modified Delphi method was used to generate 15 consensus statements/recommendations. These clinical practice recommendations will help guide clinicians managing patients with FL. Of note, the use of bispecific antibodies in R/R FL was not in the scope of this project.

100 项与 Multiplex targeted chimeric antigen receptor CAR-T cell therapy(Cellevolve) 相关的药物交易

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