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Abstract: SA-PO128

AKI Post CD19-CAR T-Cell Therapy Among Pediatric Patients at a Tertiary Hospital

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Petgrave, Yonique P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Selukar, Subodh Rajesh, St Jude Children's Research Hospital, Memphis, Tennessee, United States
  • Delos Santos, Noel, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Bissler, John J., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Talleur, Aimee, St Jude Children's Research Hospital, Memphis, Tennessee, United States
Background

Chimeric antigen receptor (CAR) T-cell therapy has shown promising responses in patients with relapsed/refractory B-cell acute lymphoblastic leukemia. In the pediatric population, the incidence of acute kidney injury (AKI) post treatment with CD19-CAR T-cell therapy remains unknown, unlike other well-established immune related complications such as cytokine release syndrome (CRS) and neurotoxicity (NTX).

Methods

The objective was to retrospectively identify the incidence of AKI in pediatric patients post treatment with lymphodepleting chemotherapy and CD19-CAR T-cell therapy, potential risk factors for AKI, and kidney function recovery. Serum creatinine values prior to CAR T-cell therapy through day 30 post therapy were used to assess AKI, defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria

Results

In the study period (11/2018 – 4/2021), 34 patients received a total of 35 CD19-CAR T-cell infusions for relapsed and/or refractory B-lineage malignancy. The median age was 9.7 yrs old (range 1.8 –23.6) at time of infusion, with most patients male (55.9%) or white (73.5%), and 28.6% previously treated with a hematopoietic cell transplant (HCT). Median baseline renal function using 24hr creatinine clearance (n=7) was 125 ml/min/1.73m2 (range 60-207) and by Technicium99 scan (n=19) 155 ml/min/1.72m2 (range 71-280). The incidence of immune related toxicities included: CRS, 60% (grade 3–4 CRS, 17%), NTX, 25.7%, and HLH-like toxicity,11.4%. The cumulative incidence of any grade AKI by day 30 was 20% (95% CI 6.5%-33.5%) with severe AKI (Stage 2-3) developing in 5 patients (14.3%). One patient required dialysis. Patients who developed AKI did so within the first 14 days of CAR T, and 50% of patients had kidney function return to baseline within 30 days. There was no association with AKI and pre-treatment risk factors, including level of disease burden in the marrow or prior HCT. In patients experiencing immune mediated side effects, AKI developed after the onset of NTX and HLH in all patients, and all but one patient with CRS.

Conclusion

Although the incidence of AKI is low in our pediatric cohort, it developed rapidly after CD19-CAR T-cell therapy. Early recognition and management of CAR T-cell therapy related complications is beneficial, as we see half of patients recovering kidney function within 30 days