Acute kidney injury after CAR-T cell therapy: Low incidence and rapid recovery Journal Article
| Authors: | Gutgarts, V.; Jain, T.; Zheng, J.; Maloy, M. A.; Ruiz, J. D.; Pennisi, M.; Jaimes, E. A.; Perales, M. A.; Sathick, J. |
| Article Title: | Acute kidney injury after CAR-T cell therapy: Low incidence and rapid recovery |
| Abstract: | Chimeric antigen receptor (CAR) T cell therapy using engineered cytotoxic T cells has shown promising responses in various hematologic malignancies. Cytokine release syndrome (CRS) and immune effector cell-associated neurologic syndrome (ICANS) are recognized toxicities of CAR-T, whereas kidney injury remains less well recognized. The objective of the present study was to identify the incidence of acute kidney injury (AKI) after CAR-T cell therapy, potential risk factors, and recovery of kidney function. We performed a retrospective review of 46 adult patients with non-Hodgkin lymphoma treated with CAR-T therapy between February 2018 and February 2019 at our institution. Serum creatinine values before CAR-T therapy through day 100 were used to assess AKI, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria: grade 1, 1.5- to <2-fold of baseline; grade 2, 2- to <3-fold of baseline; grade 3, ≥3-fold of baseline. CRS and ICANS were graded using the consensus criteria of the American Society of Transplantation and Cellular Therapy. The overall incidence of CRS was 78.3% (95% confidence interval [CI], 66% to 90.5%), of whom 13% (95% CI, 3.3% to 22.8%) developed grade 3-4 CRS, whereas the overall incidence of ICANS was lower at 45.7% (95% CI, 3.1% to 60.3%). The cumulative incidence of any grade AKI by day 100 was 30% (95% CI, 16.9% to 43.9%), with a grade 1 AKI incidence of 21.7% (95% CI, 9.7% to 33.8%) and a grade 2-3 AKI incidence of 8.7% (95% CI,. 4% to 17%). No patients developed severe AKI necessitating renal replacement therapy. Patients with previous autologous or allogeneic stem cell transplantation, those requiring intensive care unit level care and with grade 3-4 CRS had a higher incidence of AKI. Most patients recovered, with kidney function returning to baseline within 30 days. We conclude that with early recognition and management of CAR-T complications, the incidence of AKI is low, the severity of injury is mild, and most patients recover kidney function within 30 days. © 2020 American Society for Transplantation and Cellular Therapy |
| Keywords: | adult; clinical article; aged; young adult; allogeneic stem cell transplantation; incidence; creatinine; autologous stem cell transplantation; creatinine blood level; retrospective study; risk factor; acute kidney failure; intensive care unit; nonhodgkin lymphoma; kidney function; toxicity; convalescence; renal replacement therapy; very elderly; human; male; female; article; chimeric antigen receptor t-cell immunotherapy; chimeric antigen receptor t cell therapy; acute kidney impairment |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 26 |
| Issue: | 6 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2020-06-01 |
| Start Page: | 1071 |
| End Page: | 1076 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2020.02.012 |
| PUBMED: | 32088364 |
| PROVIDER: | scopus |
| PMCID: | PMC8375362 |
| DOI/URL: | |
| Notes: | Insara Jaffer Sathick's first name is not listed on the original publication -- Article -- Export Date: 1 July 2020 -- Source: Scopus |
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