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oai:recercat.cat:11351/112242025-05-03T03:20:29Zcom_2072_378070com_2072_378040com_2072_378071col_2072_378092col_2072_378097

Transient acute kidney injury after chimeric antigen receptor T-cell therapy in patients with hematological malignancies León-Román, Juan Bolufer Cardona, Monica Sánchez-Salinas, Mario Alonso-Martínez, Carla Bestard, Oriol Bermejo García, Sheila Cecilia del Carmen, Carpio Segura Garcia-Carro, Clara Barba, Pere Soler, María José IACOBONI, GLORIA Institut Català de la Salut [León-Román J, Bermejo S, Bolufer M, Bestard O, Soler MJ] Servei de Nefrologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. CSUR National Unit of Expertise for Complex Glomerular Diseases of Spain, Barcelona, Spain. [Iacoboni G] Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Carpio C, Sánchez-Salinas M, Barba P] Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. [García-Carro C] Nephrology Department, San Carlos Clinical University Hospital, Madrid, Spain. [Alonso-Martínez C] Servei de Farmàcia, Vall d’Hebron Hospital Universitari, Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Cèl·lules T - Ús terapèutic Sang - Malalties - Tractament Ronyons - Malalties - Complicacions DISEASES::Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Acute Kidney Injury ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Biological Therapy::Cell- and Tissue-Based Therapy CHEMICALS AND DRUGS::Amino Acids, Peptides, and Proteins::Proteins::Membrane Proteins::Receptors, Cell Surface::Receptors, Artificial::Receptors, Chimeric Antigen DISEASES::Neoplasms::Neoplasms by Site::Hematologic Neoplasms ENFERMEDADES::enfermedades urogenitales masculinas::enfermedades urológicas::enfermedades renales::insuficiencia renal::lesión renal aguda TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapia biológica::tratamientos basados en células y tejidos COMPUESTOS QUÍMICOS Y DROGAS::aminoácidos, péptidos y proteínas::proteínas::proteínas de membranas::receptores de superficie celular::receptores artificiales::receptores de antígenos quiméricos ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias hematológicas CAR-T therapy; Acute kidney injury; Onconephrology Terapia CAR-T; Lesión renal aguda; Onconefrología Teràpia CAR-T; Lesió renal aguda; Onconefrologia Background Acute kidney injury (AKI) occurs in 30% of patients infused with chimeric antigen receptor (CAR) T-cells. The purpose of this study was to identify risk factors and long-term outcomes after AKI in patients who received CAR T-cell therapy. Methods Medical records of 115 adult patients with R/R hematological malignancies treated with CD19-targeted CAR T-cells at Vall d'Hebron University Hospital between July 2018 and May 2021. Baseline demographic data including age, gender, ethnicity, body mass index (BMI), and co-morbidities, as well as the type of hematological neoplasia and prior lines of therapy were collected. Laboratory parameters including serum creatinine and whole blood hemoglobin were retrospectively reviewed and values were gathered for days +1, +7, +14, +21, and +28 post-infusion. Results A total of 24/115 (21%) patients developed AKI related to CAR T-cell therapy; 6/24 with AKI over chronic kidney disease (CKD). Two patients had AKI in the context of lymphodepleting (LD) chemotherapy and the other 22 after CAR T-cell infusion, starting at day+1 in 3 patients, day+7 in 13 patients, day +14 in 1 patient, day+21 in 2 patients, and day+28 in 3 patients. Renal function was recovered in 19/24 (79%) patients within the first month after infusion. Male gender, CKD, cytokine release syndrome (CRS), and immune effector cell-associated neurotoxicity syndrome (ICANS) were associated with AKI. Male gender, CKD, ICANS grade ≥3 and CRS grade ≥2 were identified as independent risk factors for AKI on multivariable analysis. In terms of the most frequent CAR T-cell related complications, CRS was observed in 95 (82%) patients and ICANS in 33 (29%) patients. Steroids were required in 34 (30%) patients and tocilizumab in 37 (32%) patients. Six (5%) patients were admitted to the intensive care unit (1 for septic shock, 4 for CRS grade ≥2 associated to ICANS grade ≥2, and 1 for CRS grade ≥3). A total of 5 (4.4%) patients died in the first 30 days after CAR T-cell infusion for reasons other than disease progression, including 4 cases of infectious complications and 1 of heart failure. Conclusion Our results suggest that AKI is a frequent but mild adverse event, with fast recovery in most patients. P.B. received research funding from the Carlos III Health Institute (PI21/0199,INT23/00072), Asociación Española contra el Cáncer (Ideas Semilla 2019) and a PERIS 2018-2020 grant from the Generalitat de Catalunya (BDNS357800). This research was funded by ISCIIII-FEDER and ISCIII RETICS REDinREN, grant number PI21/01292, ERA PerMed JTC2022 grant number AC22/00029, Río Hortega CM23/00213, Marató TV3 421/C/2020, Marató TV3 215/C/2021, and RICORS RD21/0005/0016. Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), enfermedades glomerulares complejas. 2024-03-22T10:10:06Z 2024-03-22T10:10:06Z 2024-03 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion León-Román J, Iacoboni G, Bermejo S, Carpio C, Bolufer M, García-Carro C, et al. Transient acute kidney injury after chimeric antigen receptor T-cell therapy in patients with hematological malignancies. Clin Kidney J. 2024 Mar;17(3):27. 2048-8513 https://hdl.handle.net/11351/11224 10.1093/ckj/sfae027 38500492 eng Clinical Kidney Journal;17(3) https://doi.org/10.1093/ckj/sfae027 info:eu-repo/grantAgreement/ES/PEICTI2021-2023/PI21%2F01292 info:eu-repo/grantAgreement/ES/PEICTI2021-2023/AC22%2F00029 info:eu-repo/grantAgreement/ES/PEICTI2021-2023/RD21%2F0005%2F0016 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf Oxford University Press Scientia