Opinion|Videos|November 5, 2026
Understanding the Limits of B-Cell Depletion in MG
B-cell depletion can reduce pathogenic immune activity, but persistent plasma-cell reservoirs and long-term immune effects remain important therapeutic challenges. Supported by Vor Bio Medical Affairs.
Episodes in this series
In this episode, ‘Understanding the Limits of B-Cell Depletion in MG,’ the panelists explore how CD19- and CD20-directed therapies affect different portions of the B-cell lineage and why pathogenic autoantibody production may persist despite treatment. Expert faculty explain that CD20 targeting primarily affects earlier B-cell populations, whereas CD19-directed therapy extends further toward plasmablasts and short-lived plasma cells. Long-lived plasma cells residing in protected tissue compartments may nevertheless remain intact and continue producing pathogenic antibodies.
The panel then considers the implications of broader and deeper B-cell depletion. Faculty discuss infection risk, impaired vaccine responses, hypogammaglobulinemia, rare opportunistic complications, and the importance of balancing disease control against preservation of protective immunity. They note that much of the available safety experience comes from other disease areas and that larger numbers of treated patients and longer follow-up will be required to better characterize uncommon risks in MG.
Registries are highlighted as an important potential source of longer-term comparative safety information. The panel also discusses special populations, including pregnancy, in which B-cell depletion and immunoglobulin changes may have implications for neonatal immune function.
Finally, the faculty address remaining therapeutic limitations. Although B-cell–directed therapies may offer the possibility of sustained responses or more widely spaced treatment, the durability of benefit remains an important unanswered question. Continued clinical experience will be necessary to understand which approaches can provide prolonged control while minimizing treatment burden and immune complications.
The next episode in this series, ‘Emerging CAR-T Strategies in MG,’ features the panelists discussing CD19- and BCMA-directed cellular approaches and their potential to produce deeper or more sustained immune effects.
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