A therapy built to fight blood cancers is now being tested on one of the body's most stubborn autoimmune diseases, and for Rachel Dib, a military wife and mother of three in North Carolina, it meant going from a cane and a walker to walking her kids to school. Dib was diagnosed with lupus in 2007 as a college sophomore, and nearly two decades of joint failure, multiple hand surgeries, and lost abilities later, she enrolled in a CAR T-cell therapy clinical trial at the University of North Carolina School of Medicine.
The trial, detailed by Hawaii News Now, is testing whether a treatment developed to fight cancer can also beat back lupus, a lifelong autoimmune condition in which the immune system attacks healthy cells and tissue. Lupus affects an estimated 1.5 million Americans and can cause widespread inflammation and organ damage. It has no cure, and according to the CDC, it's notoriously difficult to diagnose because its symptoms are so varied — nine in ten diagnoses occur in women between the ages of 15 and 44.
Dib said breathing and laughing hurt when her symptoms first set in. Over the years that followed, she lost the ability to play musical instruments, run, and hike, and relied on a cane on good days and a walker on bad ones. After nearly 20 years of suffering and hospital stays, she enrolled in the CAR T-cell trial at UNC, a decision that the same report notes led to her feeling more energetic just a day after her infusion. More than a year after treatment, Dib said she's now able to get up with her children, take them to school, and manage household tasks.
How a Cancer Drug Gets Repurposed for an Immune Disease
CAR T stands for chimeric antigen receptor therapy, a treatment that blends immunotherapy, genetic engineering, and personalized medicine and has historically been used to treat blood cancers. The process begins with drawing a patient's blood to extract T cells, which are then genetically reprogrammed in a laboratory so the resulting CAR T cells target B cells in the body — the same cells implicated in both blood cancers and autoimmune diseases such as lupus, per the Hawaii News Now report.
Patients undergo three days of preconditioning with chemotherapy before the reprogrammed cells are administered by infusion. Doctors describe it as a living drug, since it harnesses the patient's own immune system to fight the targeted disease rather than relying on an external pharmaceutical. Dr. Saira Sheikh, a rheumatologist and researcher at UNC who is among just a handful of doctors worldwide offering the therapy, described it as groundbreaking and said it holds incredible promise, according to the outlet's report.
Sheikh's UNC Cellular Therapy Program was originally established in 2015 to treat solid tumors and blood cancers before expanding into autoimmune disease through a multidisciplinary initiative co-led by rheumatology, hematology, and nephrology specialists, according to the Thurston Arthritis Research Center. A clinical care team overseeing preparation, administration, and follow-up for each patient includes a rheumatologist, an oncologist or hematologist, an immunologist, and a nephrologist who monitors kidney function throughout the process.
A Scientific Case for Treating Lupus Earlier
The UNC excitement builds on a 2024 landmark trial published in the New England Journal of Medicine, in which researchers in Germany found that CD19 CAR T-cell therapy achieved complete, drug-free clinical remission in 15 patients with severe autoimmune diseases, including eight with severe lupus. The study examined CD19 CAR T-cell therapy in severe autoimmune diseases.
More recently, UNC's own Thurston Arthritis Research Center researchers co-authored a perspective in Frontiers in Immunology in September arguing that administering CAR T-cell therapy earlier in systemic lupus could prevent irreversible organ damage, rather than waiting until patients reach end-stage organ failure. The argument reflects a broader push among some researchers to rethink when, not just whether, to deploy the therapy.
Lupus's toll falls unevenly. According to the Lupus Foundation of America, citing a 2021 meta-analysis of CDC national lupus registries, lupus is two to three times more prevalent among Black, Hispanic, Native American, Alaska Native, Native Hawaiian, and other Pacific Islander women than among White women. Black, Hispanic, and Native American women face significantly higher rates of severe kidney complications. A separate analysis of lupus nephritis mortality data through 2019 found a 26.1 percent decline, with the highest rate in large central metropolitan areas.
Why Doctors Are Weighing Promise Against Risk
The therapy's risks aren't hidden. In November 2023, the U.S. Food and Drug Administration issued a warning following reports of secondary T-cell malignancies in treated patients, and some manufacturers were required to add boxed warnings. Study author Dr. Magdi Elsallab said the overall benefits still outweigh risks for approved indications. An analysis of more than 12,000 CAR T-cell therapy adverse event reports, published in Blood and cited by The ASCO Post in March 2024, found second primary malignancies occurred in 4.3 percent of cases, with secondary T-cell cancers representing just 0.1 percent of total reports.
That calculus is playing out among specialists nationally. A January 2026 survey of 104 rheumatologists by Spherix Global Insights found that 98 percent viewed emerging CAR T-cell data in rheumatic diseases favorably, but 68 percent said whether the benefits outweigh the risks depends heavily on the severity of an individual patient's disease.
For now, Sheikh and her UNC colleagues remain among the few teams worldwide offering the therapy, treating it as a narrow but closely watched option for patients who have run out of other paths — like Dib did, after nearly 20 years of searching for relief.
