Allogeneic CD19 CAR-NK cell therapy for a patient with relapsed and refractory lupus nephritis.

OBJECTIVE: To monitor changes in the clinical course and adverse events following allogeneic CD19 CAR-NK cell therapy in a patient with relapsed/refractory lupus nephritis (LN). METHODS: This case report depicts a patient with severe LN refractory to available treatments (including prednisone, mycophenolate mofetil and belimumab) was treated with allogenic CD19-CAR NK cells. Prior to infusion with CD19 CAR-NK cells, this patient received condition lymphodepleting chemotherapy with cyclophosphamide 300 mg/m2/d and fludarabine 25 mg/m2/d intravenously on day - 5, - 4, and - 3. The patient's response to CD19 CAR-NK treatment was evaluated by SLEDAI-2 K score, Lupus Low Disease Activity State (LLDAS) and the Definitions of Remission in SLE (DORIS) remission criteria. RESULTS: Clinical symptoms improved rapidly after infusion of CD19-targeted CAR NK cells. Three months after CAR-NK therapy, the patient's SLEDAI-2 K score decreased from 14 to 8. Clinical remission of arthritis and alopecia was achieved one month following CAR-NK cell infusion, while clinical remission of proteinuria was observed six months after the second infusion, at which time the 2021 DORIS remission criteria were also met, and this remission has persisted through the latest follow-up at 20 months. CONCLUSION: CD19-targeted CAR-NK cell therapy achieved durable remission in a patient with relapsed/refractory LN and showed favorable safety and tolerability.