Abstract: FR-PO0709
CD19-Targeted Chimeric Antigen Receptor T Cell Therapy in an Adolescent with Systemic Lupus Erythematosus with Kidney Failure
Session Information
- Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Zheng, Chen, Zhejiang University School of Medicine Children's Hospital, Hangzhou, Zhejiang, China
- He, Xue, Zhejiang University School of Medicine Children's Hospital, Hangzhou, Zhejiang, China
- Gang, Xuan, Zhejiang University School of Medicine Children's Hospital, Hangzhou, Zhejiang, China
- Liu, Fei, Zhejiang University School of Medicine Children's Hospital, Hangzhou, Zhejiang, China
- Mao, Jianhua, Zhejiang University School of Medicine Children's Hospital, Hangzhou, Zhejiang, China
Introduction
Lupus nephritis in children tends to be more severe and common to develop into end-stage kidney disease (ESKD), which highlights the importance of early prevention of progression to ESKD. Chimeric antigen receptor (CAR) T-cells therapy targeting CD 19 has been suggested to be newly efficient in treating relapsed or refractory systemic lupus erythematosus (SLE), but with restriction in renal failure. Here we report a case of adolescent SLE with progressive nephritis treated with CAR-T therapy, showing initial efficacy and safety over 9 months of follow-up.
Case Description
This 16-year-old female patient was initially diagnosed with SLE in 2021, and have subsequently received various treatments due to relapses. Two months before presentation at our center, she experienced another relapse with newly elevated serum creatinine levels and reduced urine volume, followed by hemodialysis 2-3 times a week. Soon the patient came to our site and underwent CAR T-cells infusion at a dosage of 1×105 cells per kg body weight. With robust expansion of CAR T-cells in vivo, the patient did not experience any adverse reactions except for transient granulocytopenia and fluctuating IL-8 levels. Her latest SLEDAI-2K score has declined to 4 from 8 at baseline, presenting only with proteinuria (dropped to about 2.8g/24h). The serum creatinine and urine volume have been also improved with a prolonged dialysis interval of nearly one week. Four months after the infusion, repeated renal biopsy was performed, which showed diffuse lupus nephritis with the AI of 1/24 and the CI of 7/12.
Discussion
To our knowledge, this is the second case of adolescent refractory SLE with kidney failure successfully treated by CAR T-cells therapy. Comparing with the case reported by Tobias Krickau, the patient in our case achieved sustained remission with drug-free without serious adverse events over a longer follow-up period. However, proteinuria both lasted in more than 6 months follow up, and the one we report still requires hemodialysis. Our pathological findings suggested that some irreversible glomerular impairments have existed and may not be reversed efficiently by CAR T-cells therapy. The renal pathology prior to treatment is crucial to predict long-term prognosis. Sustaining renal damage post-CAR T-cells therapy warrants focused attention in future researches.