Abstract: TH-PO1153
Atypical Renal Lymphocytic Infiltrate: A Rare Kidney Biopsy Finding After Chimeric Antigen Receptor-T Cell Therapy for Chronic Lymphocytic Leukemia
Session Information
- Onconephrology: Emerging Biomarkers, Preclinical Models, Clinical Challenges, and Therapeutic Strategies
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Dalal, Aashvi R., Weill Cornell Medicine, New York, New York, United States
- Jaffer Sathick, Insara, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Yang, Yihe, Weill Cornell Medicine, New York, New York, United States
- Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction
Chimeric Antigen Receptor T cell therapy (CAR T) has shown durable remissions in hematologic malignancies but carries immune-mediated toxicities. Acute kidney injury (AKI) is most often pre-renal and kidney biopsies are rarely performed. We report a case of AKI following CAR-T with atypical lymphocytic infiltrate on kidney biopsy.
Case Description
A 69-year-old woman with refractory Chronic Lymphocytic Leukemia (CLL) underwent anti-CD19 CAR T (Liso Cel) with fludarabine/cytarabine conditioning. Her course was complicated by cytokine release syndrome, immune effector cell-associated hemophagocytic lymphohistiocytosis, and neurotoxicity syndrome, managed with tocilizumab, anakinra, empalumab, and steroids. Six weeks after the CAR T infusion, she re presented with polyarticular pain, rash and AKI, creatinine (Cr) of 3.4 mg/dL (baseline 0.5–0.6). Urinalysis notable for 30 mg/dL protein, 11–25 WBC/hpf; UPCR 1.12 g/g. Autoimmune serologies and complements were negative. Renal sonogram was normal. Kidney function worsened to Cr of 3.9 mg/dl prompting kidney biopsy.
Kidney biopsy revealed atypical lymphocytic infiltrate in the glomeruli and the tubulointerstitial compartment described in figure below. No CD20 or CD19 positive cells were identified, arguing against recurrent CLL. She was started on a methylprednisolone taper of 24 mg for the polyarticular pain with renal function returning to baseline.
Discussion
AKI following CAR T is often due to hemodynamic compromise where interstitial inflammation following CAR T has not been reported. Additional stains are underway to detect CAR T expression in this biopsy sample. As CAR T therapy is increasingly implemented, clinicians should consider AIN and consider kidney biopsy if pre-renal causes are already addressed.