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CD19-targeted CAR-T therapy for the treatment of refractory autoimmune diseases

 

Despite their high prevalence globally, management of autoimmune diseases (ADs) has historically been challenging, with no curative therapies available and symptom control requiring long-term treatment with corticosteroids and anti-inflammatory drugs.1 The use of CAR-T cell therapy has proven effective in treating a range of hematological B-cell malignancies and is now being proposed as a potential option for patients with ADs, due to the ability of CD19 CAR-T cells to target the autoreactive B-cells which underlie the pathophysiology of these conditions.2

At ASH 2023, Fabian Mueller, MD, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany, presented the findings of a monocentric experience of CD19-targeted CAR-T cells for the treatment of patients with refractory systemic ADs. Of the 15 patients enrolled in the study, eight had systemic lupus erythematosus (SLE), three had idiopathic inflammatory myositis (IIM), and four had systemic sclerosis (SSc). All patients had refractory disease and were treated with a median of five prior lines of therapy.

 

In 12 patients, functional reconstitution of B-cells was observed. Encouraging disease outcomes were seen in all patients, along with a favorable safety profile of the treatment, with low levels of cytokine release syndrome (CRS) and only one case of grade 1 immune-effector cell associated neurotoxicity syndrome (ICANS). All patients with SLE achieved a complete remission (CR) after three months and this was maintained in the five patients with a follow-up of 14-24 months. All patients with IIM exhibited major disease improvement after three months, and three patients with SSc experienced decreased disease activity as evidenced by a 4.3 decrease in EULAR AI. As complete cessation of immunosuppressive drugs was possible in all patients and disease outcomes were highly positive, CAR-T therapy presents an exciting avenue for long-term disease control, and possibly cure, in patients with autoantibody dependent ADs.3

A multi-center study evaluating a novel AI algorithm to differentiate between prePMF and ET

 

Prefibrotic primary myelofibrosis (prePMF) and essential thrombocythemia (ET), two distinct myeloproliferative neoplasms (MPNs), often prove challenging to differentiate between due to similarities in molecular, histopathological, and clinical features of the diseases. As the two require specific treatment strategies and median OS in patients with the conditions differs greatly, there is an unmet need for a diagnostic tool which will aid clinicians in accurately differentiating between prePMF and ET.

At ASH 2023, Andrew Srisuwananukorn, MD, The Ohio State University Comprehensive Cancer Center, Columbus, OH, discussed the development and validation of a biologically-motivated artificial intelligence (AI) algorithm using diagnostic bone marrow (BM) biopsy digital whole-slide images (WSI). The BM biopsy slides of 226 patients were digitized and a neural network (RetCCL) was pretrained using a total of 32,226 patient-derived WSI before being validated using the Moffitt external test cohort. The model was then evaluated using an area under the receiver operator curve (AUC) and qualitatively assessed by an expert hematopathologist.

 

Evaluation of the receiver operating characteristics resulted in an AUC of 0.9, and the diagnostic classification accuracy of the test cohort was 92.3%. The diagnosis of prePMF had a final sensitivity of 66.6% and a specificity of 100%. This novel AI model has the potential to become a cost-effective and rapid diagnostic tool in clinical practice, with an ability to accurately differentiate between prePMF and ET in a matter of seconds using affordable hardware. In the future, clinicians could benefit from this model for support in clinical decision-making, as an aid in choosing an appropriate targeted treatment for patients, and in guiding clinical trial enrollment.4

Safety and efficacy of an entirely oral AAA regimen in patients with newly diagnosed APL

 

The AAA regimen, which consists of oral arsenic trioxide solution, all-trans retinoic acid, and ascorbic acid, has been found to have a high efficacy in treating patients with newly diagnosed or relapsed acute promyelocytic leukemia (APL) when combined with chemotherapy. The investigation of chemotherapy-free treatment approaches is becoming increasingly popular in the field of hematological malignancies, as clinicians and researchers aim to uncover alternative therapeutic options which minimize toxicities and long-term risks associated with treatment.

Harinder Gill, MD, MBBS, The University of Hong Kong, Hong Kong, China, discussed an ongoing multicenter trial (NCT04687176) evaluating the safety and efficacy of the AAA regimen with minimized chemotherapy, in patients with newly diagnosed APL.

 

Primary outcomes of the trial were OS, relapse-free survival (RFS) and safety, and the secondary outcome was the molecular response in patients during induction, consolidation, and maintenance. 121 patients (5 pediatric, 116 adult) were enrolled into the trial and stratified into standard-risk and high-risk groups on the basis of leukocyte count, with high-risk individuals < 65 years of age receiving daunorubicin, in addition to the AAA administered to all other patients. Consolidation and maintenance with AAA began once patients achieved first complete remission (CR1), which was achieved in all 114 patients treated with AAA/AAA+daunorubicin.

Relapse occurred in only one patient (12 months after maintenance completion), who was found to possess an arsenic trioxide resistance mutation. At the three-year follow-up, efficacy and safety data were very encouraging, with an OS of 99.1%, RFS of 97.9%, and a low rate of adverse events (AEs), including no reported cardiotoxicity. Dexamethasone was used in the 58.7% of patients who experienced APL differentiation syndrome (APL-DS). Although the early deaths which occurred prior to induction must be acknowledged (n=7), this trial found high efficacy and a good safety profile when treating newly diagnosed patients of various ages and disease risk categories with a minimal chemotherapy oral AAA regimen, indicating that this approach presents a viable option for this population.5

Understanding the experiences of patients with SCD and their caregivers in the UK

 

Sickle cell disease (SCD) is a chronic, incurable condition which has increased in prevalence by 41.4% from 2000 to 2021 and affects an estimated 8 million individuals globally.6 The significant impact this disease has on quality of life (QoL) and life expectancy, due to the presence of long-term complications, means that a focus must be placed on developing effective treatments and adequately supporting patients and their families.

At ASH 2023, Oliver Shastri, MBBS, Pfizer Ltd, Surrey, UK, discussed a qualitative social media listening (SML) study conducted in the United Kingdom, which aimed to elucidate the prevalence of online conversations surrounding SCD and identify the most common themes discussed by patients. A third-party SML tool was used to conduct a 12-month historical search of disease and treatment keywords, hashtags, and website addresses, leading to the extraction of a total of 45,864 relevant online posts from various digital channels (Twitter, Instagram, TikTok, YouTube, Facebook, forums, blogs).

 

Posts which were centered around the experience of patients and caregivers were isolated from a randomized sample of 513 posts, and six common themes were identified using AI-powered theme detection in natural language processing (NLP).

Although the content of the posts analyzed was often considered to be neutral, the sentiments of the remaining posts were more often negative than positive and highlighted the prejudice and lack of empathy which patients and caregivers had experienced from HCPs. Many patients were dismissed when sharing details about their pain and the effect of the disease on their QoL, some experienced racial bias, and others found that treatment and emergency care were difficult to access and unsatisfactory. Through the use of real-world experience data, this study provides compelling evidence regarding the need for health equity in this patient population.7

References

Written by Natalie Markova
Edited by Thomas Southgate & Anya Dragojlovic Kerkache
Publishing date: 25/01/2024