Adapting oncology CAR T-cell therapy pathways for rheumatology

The Lupus Hub was pleased to speak with Ruth Pepper, Royal Free Hospital and University College London Hospitals NHS Foundation Trust (UCLH), London, UK. We asked, How can established oncology CAR T-cell therapy pathways be adapted for rheumatology? 

During this interview, Pepper discusses how established approaches from hematology and oncology can be applied to the treatment of autoimmune diseases, including systemic lupus erythematosus (SLE). She describes how existing hematology  infrastructure, expertise, and protocols for chimeric antigen receptor (CAR) T-cell therapy support the delivery of clinical trials in patients with treatment-refractory SLE. Pepper also highlights the importance of multidisciplinary collaboration between hematology, rheumatology, and nephrology teams in treatment delivery, monitoring for potential complications, and coordinating patient care.

Key learnings 

• Experience from hematology and oncology, including the long-standing use of B-cell depletion therapies, has informed the management of autoimmune diseases such as SLE.¹ 
• The delivery of CAR T-cell therapy in lupus relies on the expertise and infrastructure of hematology CAR T-cell teams, including research and clinical nurses, consultant hematologists, project managers, dedicated wards, and established protocols.^2,3 
• Patient selection and referral focus on patients with difficult-to-treat lupus who have received multiple prior lines of therapy and may benefit from access to novel therapies, such as CAR T-cell therapy, through clinical trials.^2,3 
• Structured trial pathways ensure that patients are assessed for eligibility, provide informed consent, and receive detailed information about what to expect during treatment. 
• Patients enrolled in CAR T-cell therapy trials are managed on the hematology ward for treatment administration and monitoring for potential complications, while rheumatologists and nephrologists remain closely involved in their day-to-day care.^2,3 
• Multidisciplinary collaboration is key to delivering CAR T-cell therapy to patients with lupus, combining expertise across hematology, rheumatology, and nephrology to deliver coordinated patient care.^2,3 

This educational resource is independently supported by Autolus. All content is developed by SES in collaboration with an expert steering committee. Funders are allowed no influence.