AKI after Chimeric Antigen Receptor T Cell Therapy in Patients with Relapsed Hematological Malignancies: Experience of a Brazilian Cancer Center

Background: Cytokine release syndrome (CRS) is the most frequent adverse event after chimeric antigen receptor T cell (CAR-T) therapy and can lead to multiple organ dysfunction. Acute kidney injury (AKI) is common, but usually mild. We aimed to assess the incidence of AKI,electrolyte disturbances,CRS,and mortality in a Brazilian cancer center. Methods: We retrospectively evaluated patients with relapsed hematological malignancies treated with CAR-T therapy targeting CD-19 at the A.C.Camargo Cancer Center between November 2022 and April 2024.AKI was defined using KDIGO (Kidney Disease: Improving Global Outcomes) criteria.Laboratory test parameters,including serum creatinine and electrolytes collected daily in the pre and post-infusion period were retrospectively registered during hospital stay. Results: Sixteen patients were included for analysis,age was 60,2 (36,4-67,1)years, 62,5% male. Fourteen (87,5%) had relapsed lymphoma and 12,5% acute lymphoid leukemia. CRS occurred in 87,5% of patients in a median of 3 (2-4,7) days after infusion; 81,2% of them were treated with tocilizumab and 62,5% with corticosteroids. CRS was similar in patients with and without AKI (Table). AKI occurred in 37,5% of patients 5 (3.2-15.2) days after infusion, stage 1,2, and 3 in 50%,33,3% and 16,7%% of cases,respectively.Only one patient required kidney replacement therapy.AKI recovery occurred in 83% of cases,6 (4,5-11) days after AKI diagnosis.Most common electrolyte abnormalities were:hypokalemia(25%),hyponatremia(18,7%),and hypomagnesemia(18,7%).Mortality at 90 days post-infusion was 18,7%, occurring in 16,7% AKI patients and 20% without AKI (p=0,87). Conclusion: This is the first study assessing AKI in patients treated with CAR-T therapy in Brazil, which included patients with relapsed hematological malignancies. CRS and AKI were frequently observed, AKI was usually mild and transitory.