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Case Reports
. 2024 Oct 23;10(4):e004727.
doi: 10.1136/rmdopen-2024-004727.

Sustained drug-free remission in rheumatoid arthritis associated with diffuse large B-cell lymphoma following tandem CD20-CD19-directed non-cryopreserved CAR-T cell therapy using zamtocabtagene autoleucel

David Szabo  1 , Alexandra Balogh  2 , Laszlo Gopcsa  2 , Laura Giba-Kiss  2 , Gergely Lakatos  2 , Melinda Paksi  2 , Marienn Reti  2 , Peter Takacs  3 , Pearl van Heteren  3 , Gregor Zadoyan  3 , Silke Holtkamp  3 , Toon Overstijns  3   4 , Stefan Miltenyi  3   4 , Peter Remenyi  2 , György Nagy  5   6
Affiliations
Case Reports

Sustained drug-free remission in rheumatoid arthritis associated with diffuse large B-cell lymphoma following tandem CD20-CD19-directed non-cryopreserved CAR-T cell therapy using zamtocabtagene autoleucel

David Szabo et al. RMD Open. .

Abstract

We report the case of long-term persisting rheumatoid arthritis (RA), treated with CD20-CD19 CAR-T when it became associated with diffuse large B cell lymphoma (DLBCL), resulting in a sustained drug-free remission of the preceding RA, as well as of the subsequent DLBCL that formed the indication of the CAR-T therapy using zamtocabtagene autoleucel, with a 1-year follow-up. According to our best knowledge, this is the first published clinical case report of long-term persisting RA treated with CAR-T cell therapy.

Keywords: B-lymphocytes; arthritis, rheumatoid; autoimmune diseases; hematology; therapeutics.

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Conflict of interest statement

Competing interests: DS, PT, PvH, GZ, SH, TO and SM are employees of Miltenyi Biomedicine GmbH. GN received speaker honoraria from Astra Zeneca, AbbVie, GSK, Lilly, Pfizer, MSD, Roche, Miltenyi, SOBI and Swixx.

Figures

Figure 1
Figure 1. Patient with long-term persisting RA, associated with new-onset DLBCL treated by CAR-T. This panel summarises the treatments given for RA preceding DLBCL and subsequent treatments for DLBCL, as well as RA disease activity score DAS28, anti-vimentin and anti-double-stranded DNA antibody (anti-dsDNS) levels, and Rheumatoid Factor (RF) levels. CAR-T: chimeric antigen receptor T cell; DLBCL: diffuse large B cell lymphoma; R-CNOP: rituximab, cyclophosphamide, mitoxantrone, vincristine and prednisolone; RA: rheumatoid arthritis.
Figure 2
Figure 2. Upper graph summarises the main diagnostics and the therapy administered for DLBCL. The lower left graph shows the circulating CAR-T cell numbers following CAR-T administration. The right middle graph shows representative flow cytometric analysis results of circulating CD-markered cell numbers. The right lower graph shows the IgG levels. CAR-T: chimeric antigen receptor T cell; DLBCL: diffuse large B cell lymphoma; PET: positron emission tomography; R-CNOP: rituximab, cyclophosphamide, mitoxantrone, vincristine and prednisolone.
Figure 3
Figure 3. Pretreatment, post-R-CNOP and post-CAR-T PET-CT and CT scans. CAR-T: chimeric antigen receptor T cell; DS: Deauville Score; DLBCL: diffuse large B cell lymphoma; PD: progressive disease; PET: positron emission tomography; PR: partial response; R-CNOP: rituximab, cyclophosphamide, mitoxantrone, vincristine and prednisolone; SD: stable disease.
See this image and copyright information in PMC

References

    1. Nagy G, Roodenrijs NMT, Welsing PMJ, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021;80:31–5. doi: 10.1136/annrheumdis-2020-217344. - DOI - PMC - PubMed
    1. Nagy G, Roodenrijs NMT, Welsing PMJ, et al. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2022;81:20–33. doi: 10.1136/annrheumdis-2021-220973. - DOI - PMC - PubMed
    1. Nagy G, van Vollenhoven RF. Sustained biologic-free and drug-free remission in rheumatoid arthritis, where are we now? Arthritis Res Ther. 2015;17:181. doi: 10.1186/s13075-015-0707-1. - DOI - PMC - PubMed
    1. Gergely L, Nagy Zs. Classification and Treatment of Diffuse Large B-Cell Lymphoma. Hematol Transzfuziol. 2024;57:11–8. doi: 10.1556/2068.2024.10004. - DOI
    1. Taborelli M, Montella M, Libra M, et al. The dose-response relationship between tobacco smoking and the risk of lymphomas: a case-control study. BMC Cancer. 2017;17:421. doi: 10.1186/s12885-017-3414-2. - DOI - PMC - PubMed

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