Changhai Hospital achieved the first complete remission of systemic lupus erythematosus through CAR-NK therapy

"I'm feeling very good now. Before, I was always weak and fatigue. Now, my appetite is great, and my mental state is also very good!" In the rheumatology and immunology ward of Changhai Hospital, Ms. Zhao, who was undergoing a 3-month follow-up, excitedly told Director Gao Jie with a bright smile on her face. Accompanying the patient through treatment from the age of 18 to 23, this was the first time the medical team saw Ms. Zhao's sincere, radiant smile and cheerful laughter, filling the ward with a positive and hopeful warmth. The doctors' confidence and sense of achievement were instantly ignited by Ms. Zhao's joyful and energetic state. Seeing this, the patients in the neighboring beds all came over to inquire about the treatment plan used for Ms. Zhao and actively requested to adopt the same treatment plan.

On the day of Ms. Zhao's 3-month follow-up, she took a group photo with the medical team from the rheumatology and immunology department of Changhai Hospital. From the second on the right: Director Zhao Dongbao, Director Gao Jie, Dr. Yu Yiyi, Dr. Wan Wei, and Nurse Dai Jinxu.

In 2017, Ms. Zhao was just a young high school student when she suddenly experienced polyarthralgia and hair loss. At that time, she only applied some plasters and did not pay much attention. In 2018, she visited a doctor for a cough and chest tightness, thinking it was just a common pneumonia. However, after 10 days of intravenous treatment, her condition rapidly deteriorated, presenting with symptoms of systemic edema and worsening chest tightness. She then went to the county hospital for examination and was shocked to find anemia, thrombocytopenia, a large amount of proteinuria, hematuria, serous cavity effusion, and multiple positive autoantibodies. She was diagnosed with systemic lupus erythematosus! Her family quickly took her to Changhai Hospital in Shanghai, and from then on, she began a long journey of treatment.

During her first hospital stay, she received treatment with methylprednisolone, intravenous immunoglobulin, and cyclophosphamide. However, re-examination revealed that her hemoglobin (Hb) continued to decline progressively. She then began treatment with high-dose methylprednisolone pulse therapy and transfusion of washed red blood cells. But re-examination found that her hemoglobin had dropped to 44g/L, and her platelet count also dropped to 23×10^9/L, with further exacerbation of heart failure, and the BNP value had exceeded the upper limit of the instrument's detection range. At the brink of life and death, the medical team conducted a second round of intravenous immunoglobulin treatment, added rituximab, and performed two plasma exchanges, finally pulling her back from the jaws of death. Despite the treatment, re-examination still showed a large amount of proteinuria, hematuria, recurrent polyarthralgia, and hair loss, but she did not give up and successively used cyclophosphamide, mycophenolate mofetil, and two rounds of belimumab treatment.

Such a cycle of illness and treatment has been tormenting Ms. Zhao for 5 years. In these 5 years of suffering from illness and seeking medical treatment in a strange place, Ms. Zhao has been fighting against systemic lupus erythematosus, experiencing the ups and downs of the condition and the mood swings. Her life has been greatly affected, and the tenacity and recurrence of lupus have forced her to drop out of high school to continue fighting the disease. The long-term treatment has led to family burdens, and the side effects of long-term hormone use, such as obesity, have made Ms. Zhao feel heavy and inferior.

Director Gao Jie, Ms. Zhao's attending physician, said that over the past 5 years, the medical team has adjusted multiple treatment plans, but unfortunately, Ms. Zhao's response to treatment was not good, with various long-term medication toxic and side effects and drug resistance, especially severe kidney damage from lupus. Seeing the patient's condition continue to be unrelieved, after full research and discussion, Director Gao Jie boldly proposed a new plan to try, to participate in the "first domestic and foreign clinical trial of CAR-NK cell therapy for relapsed/refractory systemic lupus erythematosus" being carried out by the rheumatology and immunology department of Changhai Hospital. CAR-NK cell therapy is a highly personalized and brand-new treatment method, which has extremely high requirements for product quality, doctor's clinical experience, and the professional quality of nursing staff. At that time, the department's CAR-NK cell therapy clinical research project had just started, and both patients and medical staff faced certain uncertainties and risk challenges.

How to treat, continue with conservative treatment or try this unknown new therapy? Brave and optimistic, Ms. Zhao demonstrated her extreme trust in the medical team of the rheumatology and immunology department of Changhai Hospital with her actions. She immediately signed the "informed consent form" and became the first person in the "CAR-NK cell therapy for relapsed/refractory systemic lupus erythematosus clinical trial" of the rheumatology and immunology department of Changhai Hospital, boldly verifying a new therapy with herself!

Ms. Zhao's courage ignited the fighting spirit and belief of the entire medical team. To guard against the critical situations that may be brought about by the potential complications of cell therapy, the medical team consulted a large number of literature on the nursing and care during the CAR-NK treatment process, from "unfamiliar" to "professional," from "flustered" to "proficient," and finally, the medical team successfully implemented CAR-NK cell therapy for Ms. Zhao, without any related complications or other critical situations during the entire treatment period.

Ms. Zhao's trust and courage finally paid off. Now, after completing 3 months of CAR-NK cell therapy, she has achieved excellent therapeutic effects: symptoms such as hair loss, joint pain, hematuria, and proteinuria have been completely relieved, her physical condition has greatly improved, and her quality of life has been greatly enhanced. On the day of the 3-month follow-up in the ward, the pleasing scene at the beginning appeared.

Ms. Zhao said that there was no discomfort during the CAR-NK cell infusion process, and it felt like a normal intravenous drip. After the treatment, she felt much better and was finally able to get out of bed and move around. She said, "The treatment effect this time is very good, much better than the previous treatment effects, and I am also very grateful to Director Gao for letting me participate in this clinical trial. For the first time, I feel hopeful about returning to my normal life before!"

Now, Ms. Zhao's condition has stabilized, and her life is gradually returning to normal. Although she missed the beautiful time of high school and university, she is still full of hope for the future. She firmly believes that as long as she does not succumb to the trials of fate, life will always bring her surprises!