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Kidney Week

Abstract: PO2168

Clinical Features of AKI in Patients Receiving Tisagenlecleucel (CAR-T Therapy)

Session Information

  • Onco-Nephrology - 1
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Lee, Meghan, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Strohbehn, Ian Austin, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Seethapathy, Harish Shanthanu, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Rusibamayila, Nifasha, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Casey, Keagan S., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Gupta, Shruti, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Frigault, Matthew, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Sise, Meghan E., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

CAR-T therapy uses genetically engineered T cells to target tumor antigens, but can lead to cytokine release syndrome (CRS), neurotoxicity, and in severe cases, AKI. Prior series demonstrated 20% incidence of AKI after axicabtagene ciloleucel (Yescarta), a CD28 costimulatory domain CAR-T. Tisagenlecleucel (Kymriah) is a 41BB CAR-T that targets CD19 on B cells but has delayed toxicities, slower expansion kinetics, longer persistence, and is associated with lower rates of severe CRS. We determined incidence and clinical features of AKI in patients receiving tisagenlecleucel.

Methods

We performed a retrospective review of adults with diffuse large B cell lymphoma treated with tisagenlecleucel at our institution between Jan 2019–Apr 2020. Baseline demographics, laboratory data, and clinical outcomes were obtained from electronic health records. The primary outcome, AKI, was defined as a ≥1.5-fold rise in creatinine from pre-CAR-T baseline and staged using KDIGO criteria.

Results

Overall, 37 patients received tisagenlecleucel: average age was 60 (SD 18), 65% male, 86% white. CRS occurred in 51% (no severe CRS); neurotoxicity occurred in 24%. Thirteen (35%) required steroids, 8 (22%) received tocilizumab, and 8 (22%) received anakinra to treat CRS/neurotoxicity. AKI occurred in 2 (5%) patients; both had stage 3 AKI. One had acute tubular necrosis due to septic shock starting post-infusion day 1. The other had AKI with new-onset nephrotic range proteinuria (5-6g/g) concurrent with a hemophagocytic lymphohistiocytosis-like syndrome beginning day +8. The patient was also receiving amphotericin and acyclovir. Both patients with AKI died (days 4 and 28, respectively). Among patients without AKI, the 30-day mortality was 8.6%. Clinically significant electrolyte disorders were also common (Table).

Conclusion

Compared to prior reports, we found lower rates of CRS and AKI in patients receiving Tisangenlecleucel. We report a case of new-onset nephrotic-range proteinuria and AKI following CAR-T.