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Abstract: TH-OR10

Renal Outcomes After Chimeric Antigen Receptor T Cell (CAR-T) Therapy: A Single-Center Perspective

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Ansari, Rehan, University Hospitals, Cleveland, Ohio, United States
  • Lee, Ho Jun, University Hospitals, Cleveland, Ohio, United States
  • Chen, Zhengyi, Case Western Reserve University, Cleveland, Ohio, United States
  • Rashidi, Arash, University Hospitals, Cleveland, Ohio, United States
Background

Recently chimeric antigen receptor T-cell immunotherapy (CAR-T) has shown promise for refractory non Hodgkin lymphoma. While involving genetically engineered self T cells to express a synthetic receptor binding to tumor antigens, a great concern is the development of cytokine release syndrome (CRS). The release of cytokines can lead to vasodilation, decreased cardiac output, and intravascular volume depletion which may potentiate renal injury. Unfortunately a paucity of data exists of renal outcomes in patients treated with CAR-T, especially with chronic kidney disease (CKD). We aim to further elucidate renal outcomes in patients treated with CAR-T at our institution.

Methods

We reviewed the course of 39 adults who received CAR-T at our institution between July 2018 and May 2021. Baseline demographics (age, gender, comorbidites), and serum laboratory values were obtained. Primary outcomes compared the incidence of acute kidney injury (AKI), death and CRS between patients with and without CKD as defined by KDIGO (kidney disease improving global outcomes). Fisher's exact tests were used to calculate associations of univariate risk ratios. Multivariate survival analysis (COX model) was conducted for all outcomes, adjusting age, gender and death between patients with and without CKD.

Results

With an average age of 58.7 years (SD=10.5), 24 males and 15 females, 14/39 had mild CKD (GFR <90 ml/min/1.73 m2) and 4/39 had moderate CKD (GFR <60 ml/min/1.73 m2). CRS was observed in 22/39 (56%) and ICU care in 6/39 (15%) cases. Of the 9 AKI cases (6 class 1, 1 class 2, 2 class 3), 5 resolved, 2 progressed and 2 patients expired. There were a total of 10 deaths (8-678 days after CAR-T). Univariately, there was a correlation between underlying hypertension and AKI with death (RR (95% CI) = 3.4 (1.2, 9.8), P=0.04; RR (95% CI) = 5.0 (1.8, 13.9), p=0.004). ICU correlated with AKI (RR (95% CI) = 4.4 (1.6, 11.8), P=0.02), but there was no association between CRS and the development of AKI. Multivariate survival analysis didn’t find any difference between patients with and without CKD.

Conclusion

Our findings did not show an increased risk of AKI or death in CKD patients treated with CAR-T. This supports the use of CAR-T in CKD patients, but with our small sample size, and lack of diverse ethnicities, more studies are needed to determine the safety of CAR-T therapy.