Overview

Graves' disease is an autoimmune disease. The TSH receptor antibody(TRab) produced by B cells drives the production of thyroid hormone, which causes systemic disorders and thyroid eye disease. The purpose of this study is to investigate the efficacy and safety of allogeneic anti-CD19 CAR-T for refractory Graves' disease.

The participants with refractory Graves' disease will receive a single dose of allogeneic anti-CD19 CAR-T and be regularly seen for the change of serum TRab, FT3, FT4 and clinical presentations, as well as any adverse events.

Eligibility

Inclusion Criteria:

• Subjects with refractory Graves disease, which is defined as meeting any one of the following criteria: a. Failure to discontinue medication after continuous standard antithyroid therapy for ≥ 3 years; b. Hyperthyroid state requiring medication after receiving ≥ 2 times of radioiodine therapy (with the last dose of radioiodine administered at least 6 months prior); c. Relapse ≥ 2 times after cessation of medication upon meeting the criteria for treatment discontinuation.
• Serum TRAb ≥ 3 times greater than normal range (≥ 5 IU/L)
• Positive expression of CD19 on peripheral blood B cells determined by flow cytometry.
• Participation in this clinical study is willing to sign an informed consent with good compliance with treatment and follow-up.

(Criteria for treatment discontinuation is define as receiving continuous anti-thyroid drug therapy for ≥18 months, and maintaining euthyroid status for ≥6 months, plus negative TRAb and TSI. Relapse is defined as recurrence of hyperthyroidism and positive TRAb/TSI after meeting the criteria for treatment discontinuation and stopping medication.)

Exclusion Criteria:

• History of severe drug allergies or allergic constitution;
• Presence or suspicion of uncontrolled infections requiring intravenous treatment (fungal, bacterial, viral or other);
• Presence of central nervous system disorders (including epilepsy, psychosis, cerebrovascular accident, encephalitis, CNS vasculitis, etc);
• Presence of clinically significant heart diseases (e.g., angina pectoris, myocardial infarction, heart failure, severe arrhythmias, etc);
• Subjects with congenital immunoglobulin deficiency;
• Patients with malignant tumors;
• Subjects who are: 1. HBsAg or HBcAb positive with detectable peripheral blood HBV DNA; 2. HCV antibody positive with detectable HCV RNA; 3. Positive HIV antibody; 4. Syphilis test positive;
• Subjects with psychiatric disorders or severe cognitive dysfunction;
• Hematopoietic function: a. White blood cell count < 3.5×10^9/L b. Neutrophil count < 1.5 x 10^9/L; c. Hemoglobin < 110g/L.
• Liver function: ALT> 3×ULN, AST > 3×ULN, TBIL > 2.5×ULN.
• Renal function: creatinine clearance rate (CrCl) < 60 ml/minute (calculated based on Cockcroft/Fault formula).
• Cardiac function: LVEF < 55%
• Coagulation function: International standardized ratio (INR) ≥ 1.5×ULN, prothrombin time(PT) >1.5 × ULN.
• Participation in other clinical trials within 3 months prior to enrollment;
• Pregnancy or planning pregnancy;
• Other conditions considered by investigators as unsuitable for participation.