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Kidney Week

Abstract: SA-OR003

Predictors of AKI in Patients Undergoing CAR T-Cell Therapy

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Metwally, Sherif, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Shaikhouni, Salma, The Ohio State University, Dublin, Ohio, United States
  • Bhatt, Udayan Y., The Ohio State University, Dublin, Ohio, United States
  • Prosek, Jason, The Ohio State University Medicial Center, Columbus, Ohio, United States
Background

Chimeric Antigen Receptor T-cell therapy (CAR-T) is an emerging immunotherapy used to treat certain malignancies. Organ dysfunction, including acute kidney injury (AKI), has been described, and hypothesized to be due to cytokine release syndrome (CRS). Predictors of AKI in patients receiving CAR-T cell therapy have not been adequately studied. We conducted a retrospective cohort study of patients receiving CAR-T cell therapy at our institution, in an attempt to identify those patients who are at risk of developing AKI after receiving this therapy.

Methods

We reviewed the charts of patients who received CAR-T between 5/2016 and 9/2018. A total of 58 patients were included in the study. Development of AKI was defined as increase in creatinine of at least 0.3 above baseline. 32% of patients (N = 19) developed AKI. Univariate analyses were conducted to delineate significant differences between patients who developed AKI compared to those who did not with regards to baseline characteristics, inflammatory markers (CRP, ferritin, albumin), markers of organ dysfunction (AST, bilirubin), and the use of any steroids or tocilizumab.

Results

Univariate analysis revealed comparable age, gender, ethnicity, as well as prevalence of hypertension and diabetes in the two groups. Patients with AKI tended to have a higher BMI (p=0.002) and baseline Cr (p=0.03). Ferritin peaked at a significantly higher level in the AKI group (p=0.008). There was no significant difference in peak CRP or albumin nadir between groups. Patients who developed AKI developed higher AST and Bilirubin levels (p=0.05, p=0.025 respectively). There was no significant difference in the rate of administration of steroids or tocilizumab in the AKI group compared to the other patients. The AKI group had a higher rate of death at 6 months after therapy (47% compared to 13%, p=0.008).

Conclusion

CAR-T cell therapy is gaining increased use for various malignancies. Models have been proposed to predict, diagnose and manage CRS, but not specifically AKI. Our findings indicate that baseline patient characteristics and inflammatory response markers, particularly ferritin, may play a role in predicting worse renal outcomes. Future work may focus on creating a broader predictive model that can help identify and guide management of patients receiving CAR-T who are at risk of AKI.