Anti-CD19 chimeric antigen receptor T cells in Evans syndrome of systemic lupus erythematosus

Evans syndrome, characterized by autoimmune hemolytic anemia and immune thrombocytopenia, is rare and often refractory to conventional therapies. In Chinese patients with systemic lupus erythematosus (SLE), its incidence is approximately 0.47%. We report the first case of anti-CD19 chimeric antigen receptor (CAR) T cell therapy for SLE-Evans syndrome. A 36-year-old woman with refractory disease received autologous CD19 CAR T cells (inati-cel) after lymphodepleting chemotherapy. CAR T cells expanded rapidly, peaking on day 7, and remained detectable for 6 months. CD19 B cells were eliminated by day 14. Hemoglobin levels improved from 48 g/L pre-infusion to 115 g/L at day 28 and stabilized. Platelet counts increased from 60,000/µL to 195,000/µL at 2 months. Only grade 1 cytokine release syndrome occurred, with no other adverse events. This case demonstrates that CD19 CAR T cell therapy is a promising approach for refractory Evans syndrome, warranting further investigation.