{
  "abstract": "Objective To evaluate the safety and efficacy of CD19 chimeric antigen receptor (CAR) T cell therapy in a patient with refractory lupus nephritis who experienced severe disease flare during immunosuppressive washout, and to assess whether pulse corticosteroid intervention affects CAR T cell therapeutic outcomes.Methods We report a single case of a 22-year-old woman with SLE and lupus podocytopathy refractory to multiple therapies including rituximab, belimumab and obinutuzumab. The patient was treated under single-patient IND (#30146) with autologous CD19 CAR T cells (KYV-101). During the preinfusion washout period, she developed severe lupus flare requiring pulse intravenous methylprednisolone. Clinical outcomes, CAR T cell expansion, B cell depletion and laboratory parameters were monitored before and after therapy.Results Despite experiencing severe lupus flare (fever, rash, arthritis, anti-dsDNA elevation, hypocomplementaemia) during washout, pulse methylprednisolone (250 mg intravenous, rapidly tapered) successfully controlled symptoms without compromising subsequent CAR T cell expansion (peak 15.5 cells/µL on day 7). The patient achieved sustained clinical remission with SLE Disease Activity Index Score decreasing from 17 prior to leukapheresis to 4 by week 17. At 12 months postinfusion, she remained in drug-free remission with stable kidney function and had returned to full-time work.Conclusion This case report illustrates that targeted pulse corticosteroids during CAR T cell therapy washout can effectively manage severe lupus flares without impairing therapeutic efficacy.",
  "authors": [
    {
      "affiliations": [
        "NYU Langone Health, New York City, New York, USA"
      ],
      "name": "Jonathan M Gerber"
    },
    {
      "affiliations": [
        "UMass Chan Medical School, Worcester, Massachusetts, USA"
      ],
      "name": "Ehsan Dehdashtian"
    },
    {
      "affiliations": [
        "UMass Chan Medical School, Worcester, Massachusetts, USA"
      ],
      "name": "Guangnan Hu"
    },
    {
      "affiliations": [
        "UMass Chan Medical School, Worcester, Massachusetts, USA"
      ],
      "name": "Cara Gregoire"
    },
    {
      "affiliations": [
        "Kyverna Therapeutics Inc, Emeryville, California, USA"
      ],
      "name": "Dominic Borie"
    },
    {
      "affiliations": [
        "UMass Chan Medical School, Worcester, Massachusetts, USA"
      ],
      "name": "Poorva Bindal"
    },
    {
      "affiliations": [
        "UMass Chan Medical School, Worcester, Massachusetts, USA"
      ],
      "name": "Jan Cerny"
    },
    {
      "affiliations": [
        "University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Abdallah Geara"
    },
    {
      "affiliations": [
        "Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Bayern, Germany"
      ],
      "name": "Georg Schett"
    },
    {
      "affiliations": [
        "UMass Chan Medical School, Worcester, Massachusetts, USA"
      ],
      "name": "Roberto Caricchio"
    }
  ],
  "title": "Successful autologous CD19 CAR T cell therapy following severe lupus flare during immunosuppressive washout in refractory lupus nephritis",
  "uid": "aa3a8441-16fe-59b5-9614-dd6b33c1dca1"
}