Abstract: TH-PO1156
Thrombotic Microangiopathy (TMA) After Tumor-Infiltrating Lymphocytes (TIL) Therapy for Metastatic Melanoma
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
- Yelamanchi, Aditya, University of California Davis, Davis, California, United States
- Llamas, Marielle, University of California Davis, Davis, California, United States
- Jen, Kuang-Yu, University of California Davis, Davis, California, United States
- Ananthakrishnan, Shubha, University of California Davis, Davis, California, United States
Introduction
Thrombotic microangiopathy (TMA) is a spectrum of disorders with multiple potential etiologies. Tumor infiltrating lymphocytes (TIL) therapy involves harvesting tumor-reactive T cells, massively expanding and activating them ex vivo, then reinfusion with IL-2 after lymphodepletion to mount a stronger antitumor immune attack. This therapy has been approved since February 2024 for melanoma not responsive to immune checkpoint inhibitors (ICI) or BRAF treatments. In this case report, we describe a case of TMA following TIL therapy (Lifileucel) in the treatment of metastatic melanoma.
Case Description
69 year old male presented with stage T1aNxM0 BRAF negative malignant melanoma of axilla diagnosed in 2019. Despite resection of a recurrent lesion, PET/CT showed progression to stage IV in 2024. Metastases worsened on imaging following 7 cycles of ICI combination therapy (LAG-3 and PD-1 checkpoint). Patient proceeded with TIL based procurement. Kidney function was normal at this time. Lifileucel (TIL therapy) and IL-2 was started following a lymphodepletion regimen of fludarabine and cyclophosphamide.
Over the next few months, patient had gradual worsening renal function, respiratory symptoms and hematologic findings consistent with microangiopathic hemolytic anemia and thrombocytopenia. CT chest revealed bilateral ground-glass opacities and centrilobular nodularity. Serum creatinine increased to 3 mg/dL with increased proteinuria around 2 g/g creatinine. Renal biopsy was done and confirmed TMA. Extensive work up of TMA was unrevealing for an alternative cause and it was suspected to be most likely related to TIL therapy. Pulmonary manifestations were also thought to be related to TMA. Eculizumab was started that significantly improved the hematologic and pulmonary symptoms. Unfortunately, as kidney function continued to get worse and with further tumor progression, the patient transitioned to comfort care.
Discussion
TMA has been described in patients with malignancies, both related to the malignancy itself and to various therapies given. We describe a patient who received TIL therapy complicated by biopsy proven TMA. Meta-analysis of 670 patients treated with TIL therapy noted 14 patients with renal failure (2.1%) but did not define etiology of renal failure. This case adds to the literature of patients with biopsy proven TMA postulated to be related to TIL therapy.