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Kidney Week

Abstract: PO2162

Checkpoint Inhibitor-Related Renal Vasculitis and Use of Rituximab

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

  • Mamlouk, Omar, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Lin, Jamie, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Abdelrahim, Maen, Houston Methodist, Houston, Texas, United States
  • Tchakarov, Amanda, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Glass, William F., University of Texas John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Selamet, Umut, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Buni, Maryam, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Abudayyeh, Ala, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Background

The percentage of cancer patients eligible for checkpoint inhibitor (CPI) therapy has increased rapidly over the past few years and approaches 45%. As a result, more cases of CPI-related nephrotoxicity, including a rare subset with vasculitis, are being reported. To elucidate the clinical presentation of CPI-associated vasculitis with kidney involvement and its possible mechanisms, treatment options, and prognosis, we describe cases from a comprehensive cancer center and reviewed the literature for similar cases.

Methods

We retrospectively reviewed the charts of all cancer patients from 2014 to 2020 who were diagnosed with CPI-related nephrotoxicity and underwent a kidney biopsy

Results

We identified 5 cases of vasculitis with kidney involvement: 3 patients were diagnosed with renal vasculitis, 1 case with ANCA vasculitis, and 1 case with Immunoglobulin A (IgA) vasculitis. Of these cases, 4 patients were receiving nivolumab, and 1 patient was receiving tremelimumab. All patients had microscopic hematuria, four out of five had negative anti-neutrophil cytoplasmic antibodies (ANCA) serology, one patient had concurrent lung involvement and positive ANCA serology, and all had severe acute kidney injury with creatinine > 4.50 mg/dL upon diagnosis. All patients were treated by discontinuing CPI and initiating corticosteroids and rituximab. Three patients received plasmapheresis; 2 of these required renal replacement therapy (RRT) including the patient with lung involvement. All patients after rituximab had partial or complete renal response. Two patients died within 8 months of diagnosis due to malignancy progression. None of the patients had a relapse of vasculitis

Conclusion

We demonstrated that CPI can be associated with different types of vasculitis with kidney involvement that are predominantly ANCA negative and manifest as severe acute kidney injury. Despite the lack of strong evidence, treatment similar to treatment of primary ANCA vasculitis with corticosteroids and rituximab is well tolerated with favorable renal outcomes

Funding

  • Other NIH Support