Kidney Week

Abstract: SA-OR004

AKI and Electrolyte Abnormalities in Patients Receiving Chimeric Antigen Receptor T-Cell (CAR-T) Therapy

Session Information

• AKI: Onco-Nephrology and Other Drugs
  November 09, 2019 | Location: Salon A/B, Walter E. Washington Convention Center
  Abstract Time: 05:06 PM - 05:18 PM

Category: Onco-Nephrology

• 1500 Onco-Nephrology

Authors

• Gupta, Shruti, BWH, Boston, Massachusetts, United States

Shruti Gupta, MD, MPH



Dr. Gupta earned her undergraduate degree at Yale University, her MD from the University of Virginia, and completed residency in Internal Medicine at Massachusetts General Hospital (MGH). She completed her Fellowship in Nephrology at the Brigham and Women’s Hospital (BWH)/MGH combined training program, during which time she also earned an MPH from the Harvard School of Public Health. Dr. Gupta is a faculty member at BWH and Director of Onco-Nephrology at Dana-Farber Cancer Institute. She is interested in investigating the nephrotoxic effects of oncologic treatments. Dr. Gupta is co-mentored by Drs. Gary Curhan and David Leaf, and is currently supported by an NIH F32 award.

• Seethapathy, Harish Shanthanu, Massachusetts General Hospital, Boston, Massachusetts, United States

Harish Shanthanu Seethapathy,

• Motwani, Shveta S., Brigham and Women's Hospital and Dana-Farber Cancer Institute, Newton, Massachusetts, United States

Shveta S. Motwani,

• Parikh, Samir M., BIDMC/Harvard Medical School, Boston, Massachusetts, United States

Samir M. Parikh,

• Curhan, Gary C., Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States

Gary C. Curhan,

• Reynolds, Kerry, Massachusetts General Hospital, Boston, Massachusetts, United States

Kerry Reynolds,

• Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States

David E. Leaf,

• Sise, Meghan E., Massachusetts General Hospital, Boston, Massachusetts, United States

Meghan E. Sise,

Background

CAR-T therapy targets tumor antigens using genetically engineered cytotoxic T-cells, and is a breakthrough treatment for hematologic malignancies. Cytokine release syndrome (CRS), a systemic inflammatory response, is a known complication of CAR-T. CRS can lead to acute kidney injury (AKI); however, scant data exist on AKI in adults. We aimed to define the incidence, clinical features, and outcomes of AKI and electrolyte abnormalities in adults receiving CAR-T.

Methods

We performed a retrospective review of adults with lymphoma treated with CAR-T at 2 major cancer centers in Boston. Baseline demographics, laboratory data, and clinical outcomes were obtained from electronic health records. AKI was defined using KDIGO criteria.

Results

Among 78 patients receiving CAR-T, CRS occurred in 85%, of whom 62% required treatment with tocilizumab. AKI occurred in 15 patients (19%): 8 were pre-renal azotemia; 6 acute tubular necrosis; and 1 urinary obstruction related to disease progression. Patients with AKI were more likely to experience higher grades of CRS (grades 3,4). The association between the underlying cause of AKI and length of stay (LOS)/mortality are shown in Figure 1. All 3 patients requiring dialysis died during the hospitalization during which they received CAR-T. Electrolyte abnormalities in the first week after CAR-T were common: hypophosphatemia < 2.0 mg/dL occurred in 51% and hyponatremia < 130mEq/L in 15%.

Conclusion

In the largest report of adverse kidney events associated with CAR-T in adults, AKI and electrolyte abnormalities occur commonly in the context of CRS.

Funding

• NIDDK Support