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
Notes: Insara Jaffer Sathick's first name is not listed on the original publication -- Article -- Export Date: 1 July 2020 -- Source: Scopus
Citation Impact
MSK Authors
  1. Junting Zheng
    167 Zheng
  2. Miguel-Angel Perales
    575 Perales
  3. Molly Anna Maloy
    242 Maloy
  4. Edgar Alberto Jaimes
    46 Jaimes
  5. Tania Jain
    25 Jain
  6. Josel Dumo Ruiz
    31 Ruiz
  7. Martina Pennisi
    22 Pennisi