Abstract: TH-PO0165
Kidney and Functional Outcomes After Chimeric Antigen Receptor T Cell Therapy in Multiple Myeloma vs. Diffuse Large B Cell Lymphoma: A Real-World Matched Cohort Study
Session Information
- Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Khan, Fayaz Aijaz Ahmed, TriHealth Inc, Cincinnati, Ohio, United States
- Capriles, Guido M, TriHealth Inc, Cincinnati, Ohio, United States
- Singeltary, Brian, TriHealth Inc, Cincinnati, Ohio, United States
Background
Chimeric antigen receptor T-cell (CAR-T) therapy is increasingly used in relapsed hematologic malignancies, yet comparative renal and systemic toxicity profiles across diseases remain understudied. Multiple myeloma (MM) and diffuse large B-cell lymphoma (DLBCL) CAR-T constructs differ in target, lymphodepletion, and patient comorbidities, which may influence acute and long-term renal outcomes. This study evaluates renal and functional complications following CAR-T therapy in a large real-world matched cohort.
Methods
We queried the TriNetX Global network (147 HCOs). MM CAR-T recipients (idecabtagene or ciltacabtagene) were compared with DLBCL CAR-T recipients (axicabtagene, lisocabtagene, or tisagenlecleucel). Adults ≥18 years were included. Patients with prior CAR-T or ESRD were excluded. A 1:1 propensity score match was performed on demographics, comorbidities (including baseline CKD), and prior transplant status.
Results
After matching (N=1,224 per group), MM patients had significantly lower mortality (15.4% vs 21.6%, p=0.001). Acute kidney injury (AKI) rates were similar (14.7% MM vs 16.1% DLBCL, p=0.31). However, dialysis initiation was lower in MM (4.5% vs 6.7%, p=0.04), and progression to GFR ≤30 mL/min/1.73m2 trended lower (6.1% vs 8.1%, p=0.09). Tumor lysis syndrome (TLS) was more frequent in MM (2.2% vs 1.3%, p=0.03).
CRP ≥30 mg/L was more common in DLBCL (mean 6.3 vs 4.8 events, p<0.001), reflecting a greater inflammatory response. Peripheral neuropathy was similar (1.9% MM vs 2.3% DLBCL, p=0.37). Hospitalization occurred in 86.4% of DLBCL vs 79.8% of MM patients (p=0.06), and outpatient follow-up exceeded 98% in both groups.
Conclusion
In this large real-world matched analysis, MM CAR-T recipients had lower mortality and reduced dialysis needs compared to DLBCL, despite similar AKI rates. DLBCL patients experienced more inflammatory complications, including higher CRP levels and greater hospitalization burden. These findings highlight disease-specific toxicity patterns that should inform risk stratification, supportive care protocols, and early nephrology engagement in CAR-T recipients.