Incidence and Risk Factors for Acute Kidney Injury After Chimeric Antigen Receptor T-Cell Therapy |
| |
| Affiliation: | 1. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN;2. Division of Hematology, Mayo Clinic, Rochester, MN;3. Quantitative Health Sciences, Mayo Clinic, Rochester, MN;1. Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Phoenix, AZ;2. Advisor to residents and Consultant in Hematology and Oncology, Mayo Clinic, Phoenix, AZ;1. Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN;2. Fellow in Pulmonary and Critical Care Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN;3. Advisor to resident and fellow and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN;1. Université de Paris, Service de Néphrologie et Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique–Hôpitaux de Paris, France;2. Service de Physiologie, Hôpital Necker-Enfants Malades, Assistance Publique–Hôpitaux de Paris, France;3. Université de Paris, Equipe Mobile Infectiologie, Hôpital Paris Centre, Assistance Publique–Hôpitaux de Paris, France;1. Department of Dermatology, Mayo Clinic, Rochester, MN;2. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN;1. Department of Cardiovascular Surgery, Rochester, MN;2. Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN |
| |
| Abstract: | ObjectiveTo evaluate the association of baseline and postinfusion patient characteristics with acute kidney injury (AKI) in the month after chimeric antigen receptor T-cell (CAR-T) therapy.MethodsWe retrospectively reviewed records of 83 patients with non-Hodgkin lymphoma undergoing CAR-T therapy (axicabtagene ciloleucel) between June 2016 and November 2020. Patients were followed up to 1 month after treatment. Post–CAR-T AKI was defined as a more than 1.5-fold increase in serum creatinine concentration from baseline (on the day of CAR-T infusion) at any time up to 1 month after CAR-T therapy.ResultsOf 83 patients, 14 (17%) developed AKI during follow-up. At 1 month after CAR-T infusion, 10 of 14 (71%) AKI events had resolved. Lower baseline estimated glomerular filtration rate, use of intravenous contrast material, tumor lysis prophylaxis, higher peak uric acid and creatine kinase levels during follow-up, and change in lactate dehydrogenase from baseline to peak level within 1 month after initiation of CAR-T therapy were significantly associated with AKI incidence during follow-up. Incidence of AKI was also higher in patients who received higher doses of corticosteroids and tocilizumab.ConclusionAcute kidney injury occurred in approximately 1 in 6 patients who received axicabtagene ciloleucel for non-Hodgkin lymphoma. Patients with high tumor burden receiving higher total doses of corticosteroids or tocilizumab should be closely monitored for development of AKI. Lower baseline kidney function at CAR-T initiation, exposure to contrast material, and progressive increase in levels of tumor lysis markers (uric acid, lactate dehydrogenase, creatine kinase) after CAR-T infusion may predict risk of AKI during the 1 month after infusion. |
| |
| Keywords: | AKI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0015" }," $$" :[{" #name" :" text" ," _" :" acute kidney injury CAR-T" },{" #name" :" keyword" ," $" :{" id" :" kwrd0025" }," $$" :[{" #name" :" text" ," _" :" chimeric antigen receptor T cell CK" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" creatine kinase CKD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" chronic kidney disease CRP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" C-reactive protein CRS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" cytokine release syndrome eGFR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" estimated glomerular filtration rate HLH/MAS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" hemophagocytic lymphohistiocytosis/macrophage activation syndrome ICANS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" immune effector cell–associated neurotoxicity syndrome ICU" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" intensive care unit IQR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" interquartile range IV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0125" }," $$" :[{" #name" :" text" ," _" :" intravenous LDH" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" lactate dehydrogenase NHL" },{" #name" :" keyword" ," $" :{" id" :" kwrd0145" }," $$" :[{" #name" :" text" ," _" :" non-Hodgkin lymphoma RRT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0155" }," $$" :[{" #name" :" text" ," _" :" renal replacement therapy SCr" },{" #name" :" keyword" ," $" :{" id" :" kwrd0165" }," $$" :[{" #name" :" text" ," _" :" serum creatinine |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
