Chimeric Antigen Receptor T Cell Therapy-Associated AKI: Single-Center Experience

Background: Chimeric antigen receptor (CAR) T-cell therapy is a treatment option in hematologic malignancies. Prior studies estimate the incidence of acute kidney injury (AKI) after CAR T-cell to be approximately 20%. We report single-center data on adults who received CAR T-cell therapy, as well as the incidence and characteristics of patients who developed AKI Methods: A retrospective analysis was performed on 117 patients who received CAR T-cell therapy from 01/2016 to 03/2024. Presence and staging of AKI were identified based on the serum creatinine KDIGO criteria, post-CAR-T infusion. Data were stratified by type of malignancy and timing of onset, and duration of AKI Results: Our cohort consisted of 117 patients, who had a median age of 63 years, and 71 (61%) were male. 50% had a diagnosis of multiple myeloma (MM), with the remainder diagnosed with other hematologic malignancies (see table). At baseline, the median estimated glomerular filtration rate was 97 mL/min, the median serum creatinine level was 0.80 mg/dL, and 8 (6.8%) patients had an eGFR of less than 60 mL/min. By Day 2 post-infusion, 13 patients (11%) developed AKI: ten with stage 1, two with stage 2, and one with stage 3 AKI. Among these patients, 6(10%) had a diagnosis of MM, and 5 had diffuse large B-cell lymphoma. The cumulative incidence of AKI by day 7 was 15.3%, with 14 cases of stage 1, two cases of stage 2, and two cases of stage 3 AKI. No patient required dialysis. Conclusion: In our cohort, AKI occurred in 15% of patients who received CAR T-cell therapy within the 7-days post-infusion, with most cases presenting as stage 1. AKI was most common in those with MM and DLBCL. Further studies are needed to understand risk factors and preventive strategies for post-CAR-T AKI Baseline Characteristics - Characteristic Value Age, median (range) 63 (21–83) Male sex, n (%) 71 (61) Race White, n (%) Black, n (%) Other, n (%) -79 (68)28 (24)10 (9) Malignancy diagnosis Mantle cel lymphoma, n (%) Acute lymphocytic leukemia, n (%) Follicular lymphoma, n (%) Diffuse large B-cell lymphoma, n (%) Multiple myeloma, n (%) Chronic lymphocytic leukemia, n (%) Lymphoplasmacytic lymphoma, n (%) -6 (5)8 (7)3 (3)37 (32)59 (50)3 (3)1(1) Baseline GFR, ml/min, median (range) 97 (38-153) Baseline creatinine, mg/dl, median (range) 0.80 (0.3-1.5)