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- Title
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.
- Authors
Petgrave, Yonique; Selukar, Subodh; Epperly, Rebecca; Naik, Swati; Santos, Noel DeLos; Triplett, Brandon M.; Gottschalk, Stephen; Bissler, John; Talleur, Aimee C.
- 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.
- Subjects
UNITED States; 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
- Publication
Pediatric Nephrology, 2024, Vol 39, Issue 8, p2495
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-024-06331-7