TY - JOUR
T1 - Acute Kidney Injury and Electrolyte Abnormalities After Chimeric Antigen Receptor T-Cell (CAR-T) Therapy for Diffuse Large B-Cell Lymphoma
AU - Gupta, Shruti
AU - Seethapathy, Harish
AU - Strohbehn, Ian A.
AU - Frigault, Matthew J.
AU - O'Donnell, Elizabeth K.
AU - Jacobson, Caron A.
AU - Motwani, Shveta S.
AU - Parikh, Samir M.
AU - Curhan, Gary C.
AU - Reynolds, Kerry L.
AU - Leaf, David E.
AU - Sise, Meghan E.
N1 - Funding Information:
Dr Gupta receives grant support from the National Institutes of Health (NIH; F32 DC017342-02 ); Dr Curhan, from NIH ( K24DK091417 ); Dr Leaf, from NIH ( 5K23DK10644805 ); and Dr Sise, from NIH ( 1K23DK117014-01 ). The funders did not have a role in study design, data collection, analysis, reporting, or the decision to submit for publication.
Publisher Copyright:
© 2019 National Kidney Foundation, Inc.
PY - 2020/7
Y1 - 2020/7
N2 - Rationale & Objective: Cytokine release syndrome is a well-known complication of chimeric antigen receptor T-cell (CAR-T) therapy and can lead to multiorgan dysfunction. However, the nephrotoxicity of CAR-T therapy is unknown. We aimed to characterize the occurrence, cause, and outcomes of acute kidney injury (AKI), along with the occurrence of electrolyte abnormalities, among adults with diffuse large B-cell lymphoma receiving CAR-T therapy. Study Design: Case series. Setting & Participants: We reviewed the course of 78 adults receiving CAR-T therapy with axicabtagene ciloleucel or tisagenlecleucel at 2 major cancer centers between October 2017 and February 2019. Baseline demographics, comorbid conditions, medications, and laboratory values were obtained from electronic health records. AKI was defined using KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The cause, clinical course, and outcome of AKI events and electrolyte abnormalities in the first 30 days after CAR-T infusion were characterized using data contained in electronic health records. Results: Among 78 patients receiving CAR-T therapy, cytokine release syndrome occurred in 85%, of whom 62% were treated with tocilizumab. AKI occurred in 15 patients (19%): 8 had decreased kidney perfusion, 6 developed acute tubular necrosis, and 1 patient had urinary obstruction related to disease progression. Those with acute tubular necrosis and obstruction had the longest lengths of stay and highest 60-day mortality. Electrolyte abnormalities were common; hypophosphatemia, hypokalemia, and hyponatremia occurred in 75%, 56%, and 51% of patients, respectively. Limitations: Small sample size; AKI adjudicated by retrospective chart review; lack of biopsy data. Conclusions: In this case series of patients with diffuse large B-cell lymphoma receiving CAR-T therapy, AKI and electrolyte abnormalities occurred commonly in the context of cytokine release syndrome.
AB - Rationale & Objective: Cytokine release syndrome is a well-known complication of chimeric antigen receptor T-cell (CAR-T) therapy and can lead to multiorgan dysfunction. However, the nephrotoxicity of CAR-T therapy is unknown. We aimed to characterize the occurrence, cause, and outcomes of acute kidney injury (AKI), along with the occurrence of electrolyte abnormalities, among adults with diffuse large B-cell lymphoma receiving CAR-T therapy. Study Design: Case series. Setting & Participants: We reviewed the course of 78 adults receiving CAR-T therapy with axicabtagene ciloleucel or tisagenlecleucel at 2 major cancer centers between October 2017 and February 2019. Baseline demographics, comorbid conditions, medications, and laboratory values were obtained from electronic health records. AKI was defined using KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The cause, clinical course, and outcome of AKI events and electrolyte abnormalities in the first 30 days after CAR-T infusion were characterized using data contained in electronic health records. Results: Among 78 patients receiving CAR-T therapy, cytokine release syndrome occurred in 85%, of whom 62% were treated with tocilizumab. AKI occurred in 15 patients (19%): 8 had decreased kidney perfusion, 6 developed acute tubular necrosis, and 1 patient had urinary obstruction related to disease progression. Those with acute tubular necrosis and obstruction had the longest lengths of stay and highest 60-day mortality. Electrolyte abnormalities were common; hypophosphatemia, hypokalemia, and hyponatremia occurred in 75%, 56%, and 51% of patients, respectively. Limitations: Small sample size; AKI adjudicated by retrospective chart review; lack of biopsy data. Conclusions: In this case series of patients with diffuse large B-cell lymphoma receiving CAR-T therapy, AKI and electrolyte abnormalities occurred commonly in the context of cytokine release syndrome.
KW - Chimeric antigen receptor T-cell (CAR-T)
KW - acute kidney injury (AKI)
KW - adverse event
KW - case series
KW - cytokine release syndrome
KW - diffuse large B-cell lymphoma (DLBCL)
KW - electrolyte abnormalities
KW - hypokalemia
KW - hyponatremia
KW - hypophosphatemia
KW - immunotherapy
KW - nephrotoxicity
KW - pre-renal azotemia
KW - renal failure
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U2 - 10.1053/j.ajkd.2019.10.011
DO - 10.1053/j.ajkd.2019.10.011
M3 - Article
C2 - 31973908
AN - SCOPUS:85078635798
SN - 0272-6386
VL - 76
SP - 63
EP - 71
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 1
ER -