• Chimeric Antigen Receptor T cell therapy is an efficacious anticancer therapy that has revolutionized lymphoma treatment and is now being studied in autoimmune disorders. Members of the cell therapy committee of the ASTCT and select leaders in the treatment of autoimmune disorders produced this expert panel opinion piece in question-and-answer format addressing specific considerations in CAR-T in autoimmune disorders in adult and pediatric patients. The purpose is to provide a reference for academic and community centers wishing to develop CAR-T program in autoimmunity. Topics described in detail include a review of the evidence for CAR-T in autoimmune disorder highlighting deep and durable responses with the one-time treatment without need for ongoing immunosuppression unlike traditional therapy for autoimmune disorders, specific unanswered questions regarding lymphodepletion chemotherapy, benefit of autologous and allogeneic CAR-T products, logistical, financial, infrastructure and other challenges with CAR-T in autoimmune disorder and how to address them with a multidisciplinary approach. The panel also described in detail what clinical trials are needed, the ideal pediatric and adult clinical trial candidate, patient monitoring and how to implement a long-term CAR-T clinic. The panel also enumerated how oncology and rheumatology can better collaborate to improve outcomes. Chimeric Antigen Receptor (CAR) T-cell therapy is a standard of care in many lymphoid malignancies and has emerged as potentially curative. A unique property of this one-time treatment is profound and long-lasting B cell depletion, hence the quest to explore its impact in the treatment of severe autoimmune disorders. Early trials in select populations have shown preliminary benefit. However, many questions persist as to how best to deploy this potentially highly effective therapy in the treatment of autoimmune disorders. The American Society for Transplantation and Cellular Therapy Committee on Cellular Therapy convened a group of experts in hematology, oncology, and autoimmunity to provide in a question and answer format a review of the existing publications on CAR-T cell therapy in autoimmune disorders including subtypes, discuss types of clinical trials, strategies to optimize patient safety, monitoring and toxicity management, tracking organ dysfunction in different types of autoimmune disorders, and financial considerations with the goal of providing a guide to physicians who want to be involved in CAR-T cell therapy in autoimmune disorders.
Oluwole et al. (Fri,) studied this question.