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
-
Petgrave Y, Selukar S, Epperly R, Naik S, Santos ND, Triplett BM, Gottschalk S, Bissler J, and Talleur AC
- Subjects
- Humans, Adolescent, Male, Female, Retrospective Studies, Child, Young Adult, Incidence, Child, Preschool, Risk Factors, Adult, Precursor B-Cell Lymphoblastic Leukemia-Lymphoma therapy, Precursor B-Cell Lymphoblastic Leukemia-Lymphoma immunology, Precursor B-Cell Lymphoblastic Leukemia-Lymphoma complications, Receptors, Antigen, T-Cell immunology, Receptors, Chimeric Antigen immunology, Acute Kidney Injury therapy, Acute Kidney Injury etiology, Acute Kidney Injury immunology, Acute Kidney Injury epidemiology, Immunotherapy, Adoptive adverse effects, Immunotherapy, Adoptive methods, Antigens, CD19 immunology
- 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 2-3) 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., (© 2024. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)
- Published
- 2024
- Full Text
- View/download PDF