类风湿性自身免疫疾病不仅涉及自体抗体的产生，还表现出T细胞功能障碍。对于既患有B细胞非霍奇金淋巴瘤（NHL）又患有类风湿性自身免疫疾病的患者，CD19靶向嵌合抗原受体（CAR）T细胞治疗的安全性和疗效尚不清楚。通过集聚的电子健康记录数据库，将患有类风湿性自身免疫疾病的患者（自动组）与与之倾向性匹配的没有类风湿性自身免疾病的患者（非自动组）进行了比较。从2019年1月到2023年1月，1363名接受了CD19靶向CAR T细胞治疗的患者中，有58例（4.3%）同时患有类风湿性自身免疫疾病。两组患者的细胞因子释放综合征（CRS）和免疫效应细胞相关性神经毒性综合征（ICANS）的发病率、严重程度和管理情况相似。此外，两组患者的下一次治疗或死亡时间也相似（风险比[HR] 0.97，95％置信区间[CI] 0.60至1.59，对数秩P = 0.91），以及总体生存期（HR 0.90，95％CI 0.46至1.78，P = 0.76）。在CAR T细胞输注后，类风湿性自身免疫疾病患者的炎症标志物减少，自体抗体消失，而激素和改变疾病病程的药物使用也减少。总之，类风湿性自身免疫疾病患者的CAR T细胞治疗的安全性和疗效无受影响，并且取得了更好的基础性类风湿性疾病的生化控制。© 2023作者（由Springer Nature予以独家许可）。

Rheumatic autoimmune diseases not only involve the production of autoantibodies but also demonstrate T-cell dysfunction. In patients with concurrent B-cell non-Hodgkin lymphoma (NHL) and rheumatic autoimmune diseases, the safety and efficacy of CD19-targeted chimeric antigen receptor (CAR) T-cell therapy are unknown. Using an aggregated electronic health record database, patients with rheumatic autoimmune diseases (auto group) were compared to propensity score-matched patients without rheumatic autoimmune diseases (non-auto group). From 1/2019 to 1/2023, 58 (4.3%) of 1,363 patients who received CD19-targeted CAR T-cell therapy had concurrent rheumatic autoimmune diseases. Both groups had similar incidence, severity, and management of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Moreover, the two groups had similar time-to-next treatment or death (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.60 to 1.59, log-rank p = 0.91) and overall survival (HR 0.90, 95%CI 0.46 to 1.78, p = 0.76). Following CAR T-cell infusion, patients with rheumatic autoimmune diseases achieved decreased inflammatory markers, seronegative conversion of autoantibodies, as well as reduced use of steroids and disease-modifying anti-rheumatic drugs. In conclusion, the safety and efficacy of CAR T-cell therapy were not affected in patients with rheumatic autoimmune diseases. Moreover, they achieved better biochemical control of underlying rheumatic diseases.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.