1. Acute kidney injury following treatment with CD19-specific CAR T-cell therapy in children, adolescent, and young adult patients with B-cell acute lymphoblastic leukemia.
- Author
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Petgrave, Yonique, Selukar, Subodh, Epperly, Rebecca, Naik, Swati, Santos, Noel DeLos, Triplett, Brandon M., Gottschalk, Stephen, Bissler, John, and Talleur, Aimee C.
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IMMUNIZATION , *RESEARCH funding , *THERAPEUTICS , *RENAL replacement therapy , *ACUTE kidney failure , *RETROSPECTIVE studies , *SEVERITY of illness index , *LYMPHOBLASTIC leukemia , *B cell lymphoma , *CELL receptors , *DISEASE incidence , *ADOLESCENCE , *CHILDREN , *ADULTS - Abstract
Background: CD19-specific chimeric antigen receptor (CAR) T-cell therapy has shown promising disease responses in patients with high-risk B-cell malignancies. However, its use may be related to complications such as immune-mediated complications, infections, and end-organ dysfunction. The incidence of post-CAR T-cell therapy acute kidney injury (AKI) in the children, adolescent, and young adult (CAYA) patient population is largely unreported. Methods: The objectives of this study were to determine the incidence of AKI in CAYA patients with high-risk B-cell malignancies treated with CD19-CAR T-cell therapy, evaluate potential risk factors for developing AKI, and determine patterns of kidney function recovery. We conducted a retrospective analysis of 34 CAYA patients treated with CD19-CAR T-cell at a single institution. Results: There was a cumulative incidence of any grade AKI by day 30 post-infusion of 20% (n = 7), with four cases being severe AKI (stages 2โ3) and one patient requiring kidney replacement therapy. All episodes of AKI developed within the first 14 days after receiving CAR T-cell therapy and 50% of patients with AKI recovered kidney function to baseline within 30 days post-infusion. No evaluated pre-treatment risk factors were associated with the development of subsequent AKI; there was an association between AKI and cytokine release syndrome and neurotoxicity. We conclude that the risk of developing AKI following CD19-CAR T-cell therapy is highest early post-infusion, with most cases of AKI being severe. Conclusions: Frequent monitoring to facilitate early recognition and subsequent management of kidney complications after CD19-CAR T-cell therapy may reduce the severity of AKI in the CAYA patient population. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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