CAR T-cell therapy enables safe pregnancies in autoimmune patients

Autoimmune diseases such as systemic lupus erythematosus mainly affect young women, often in a phase of their lives where they would like to have children. The diseases themselves or the immunosuppressive drugs required to treat them make pregnancy difficult or can even make it temporarily impossible to get pregnant. CAR T-cell therapy can provide a decisive advantage for these young women, since it can halt progression of the disease in the long term. An international study led by Prof. Dr. Georg Schett (Director of the Department of Medicine 3 – Rheumatology and Immunology at Uniklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg) shows for the first time that after successful CAR T-cell therapy, women with autoimmune diseases can experience normal pregnancies without complications and give birth to healthy babies. The findings have now been published in the New England Journal of Medicine.

Autoimmune diseases primarily affect young women and interfere with their plans for starting a family. Pregnancy in women with autoimmune diseases is more risky for a number of reasons. Firstly, disease activity can affect wellbeing and organ function in the kidneys, heart and lungs and pose a risk to both the mother and child. Secondly, many immunosuppressive drugs are not safe to take during pregnancy and patients must stop taking them. In addition, autoimmune diseases such as lupus often worsen during pregnancy and pose a high risk for the life of both the mother and the child.

How can CAR T-cell therapy help patients?

CD19 CAR T-cell therapy involves the targeted elimination of B cells that cause disease, enabling long-term remission of the disease for many patients. After treatment, patients no longer require immunosuppressive medication and regain their quality of life.

What is known about pregnancy and CAR T-cell therapy?

In a groundbreaking study led by Prof. Dr. Georg Schett which involved research groups from Germany, Switzerland, France, Belgium and the USA, researchers were able to demonstrate that CAR T-cell therapy can help women with autoimmune diseases to have normal pregnancies and give birth to healthy babies. The researchers systematically analyzed pregnancies after CAR T-cell therapy in patients with severe autoimmune diseases for the first time. A total of 14 pregnancies and 8 births were documented in young women with autoimmune diseases. No complications were reported in any of the pregnancies and all babies were born healthy and developed an immune system that corresponded with their age. 

Disease does not return, medication no longer required

Another exciting finding from this study is that the autoimmune disease did not return during the pregnancies, even though patients had stopped taking their immunosuppressive medication. This high degree of freedom, resulting from the cure, or at least the remission of the chronic illness and the complete discontinuation of treatment supports young women in their decision to have children and start a family. Successful CAR T-cell therapy will therefore bring long-term health and a self-determined life for women with autoimmune diseases to the forefront.