CAR T-Cell Therapy Safe in Those With Autoimmune Disease

TOPLINE:

Patients with and without preexisting autoimmune or inflammatory disease show similar safety and cancer outcomes after chimeric antigen receptor (CAR) T-cell therapy for cancer.

METHODOLOGY:

• Researchers conducted a retrospective cohort study (2017-2023) at the Dana-Farber Cancer Institute, Boston, to investigate safety, cancer progression, and autoimmune or inflammatory disease activity in patients with and without preexisting autoimmune or inflammatory disease who received CAR T-cell therapy for cancer.
• They included 499 patients with lymphoma receiving CD19-targeted CAR T-cell therapy and 105 patients with multiple myeloma receiving B-cell maturation antigen–targeted CAR T-cell therapy, of whom 47 and 6 patients, respectively, had preexisting autoimmune or inflammatory disease.
• The researchers explored the presence and severity of cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome and progression-free and overall survival during a median follow-up duration of 9.4 months.

TAKEAWAY:

• In patients with lymphoma, the occurrence of cytokine release syndrome was not different between those with and without preexisting autoimmune or inflammatory disease. Severe cytokine release syndrome occurred in 5% of patients without preexisting autoimmune or inflammatory disease but did not occur in any patient with preexisting autoimmune or inflammatory disease.
• No difference was noted in the occurrence or severity of immune effector cell–associated neurotoxicity syndrome between patients with and without preexisting autoimmune or inflammatory disease in those with lymphoma, with similar findings observed in those with multiple myeloma.
• No association was observed between preexisting autoimmune or inflammatory disease and progression-free or overall survival.
• In the year after vs before CAR T-cell therapy, less medication use for systemic immunosuppression (13% vs 25%; P = .008), fewer autoimmune or inflammatory disease flares (2% vs 15%; P = .01), and more patients in remission or low disease activity (98% vs 85%; P = .005) were observed. Autoimmune or inflammatory disease flare after CAR T-cell therapy was documented in only one patient.

IN PRACTICE:

“These findings provide reassurance around the safety of CAR T-cell therapy for patients with cancer with autoimmune or inflammatory diseases and inform ongoing prospective studies of CAR T-cell therapy to treat these patients,” the authors wrote.

SOURCE:

This study was led by Kathleen M.M. Vanni, Brigham and Women’s Hospital, Boston. It was published online on January 28, 2025, in The Lancet Rheumatology.

LIMITATIONS:

The preexisting autoimmune or inflammatory disease group included many heterogeneous diseases with a small sample size for specific conditions. Only a few patients had ongoing autoimmune or inflammatory disease during CAR T-cell therapy. Different CD19-targeted CAR T-cell products might yield varying results. This retrospective study lacked validated measures of autoimmune disease activity, and the single-center design may limit generalizability.

DISCLOSURES:

Several authors received support from multiple organizations, including the National Institutes of Health, Rheumatology Research Foundation, and National Institute of Arthritis and Musculoskeletal and Skin Diseases, among others. Many authors reported having financial ties with several pharmaceutical and biotechnology companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.