Dados do Resumo

Título

Acute kidney injury after chimeric antigen receptor T-cell therapy in patients with relapsed hematological malignancies: experience of a Brazilian cancer center

Introdução

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.

Objetivo

We aimed to assess the incidence of AKI , electrolyte disturbances, CRS, and mortality after CAR-T infusion in a Brazilian cancer center.

Métodos

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.

Resultados

Sixteen patients were included for analysis, age was 60,2 (36,4-67,1) years, 10 (62,5%) male and ECOG 0 and 1 in 87,5%. Fourteen (87,5%) had relapsed large B-cell lymphoma and two (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 (p=0,69). 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%),andhypomagnesemia(18,7%). Mortality at 90 days post-infusion was 18,7%, occurring in 1 (16,7%) AKI patients and 2 (20%) without AKI (p=0,87).

Conclusões

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.

Palavras Chave

Acute Kidney injury Cytokine release syndrome chimeric antigen receptor T cell