Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of relapsed/refractory B-cell malignancies. However, there is no data on the safety and efficacy of CAR T-cell therapy in patients with end stage renal disease (ESRD) requiring dialysis. In this report, we present two patients with DLBCL and ESRD who were successfully treated with different CAR T-cell products. Patient #1 is a 66 year-old woman with a history of HIV who was treated to complete response with axicabtagene ciloleucel with treatment complicated by grade 1 cytokine release syndrome (CRS) and grade 2 immune effector cell-associated neurolotoxicity syndrome (ICANS). Patient #2 is 52 year old woman whose ESRD was caused by ifosphamide toxicity and was treated to complete response with lisocabtagene maraleucel and did not experience either CRS or ICANS. Both patients received lymphodepletion chemotherapy with fludarabine and cyclophosphamide, which was dose-adjusted for ESRD with scheduled dialysis 12 h after each dose of lymphodepletion chemotherapy. Patients with DLBCL and ESRD can be safely administered both lymphodepletion chemotherapy and CAR T-cell therapy. Additionally, the fact that both patients achieved complete response to therapy suggests that CAR T-cell therapy should be strongly considered in patients with ESRD. Long-term follow up is needed to determine if therapy in this setting is of curative intent.

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Since then, six additional PD-1 and PD-L1 inhibitors have received FDA approval for various indications, including solid tumors, lymphomas, and tumors defi cient in DNA mismatch repair mechanisms. Although the advent of ICIs was a breakthrough in cancer therapy, these drugs can cause unique adverse reactions, which may be life-threatening. ICI toxicities generally involve the immune system, and these toxicities are referred to as immune-related adverse events. The most frequently involved organs are the skin, colon, endocrine organs, liver, and lungs. More serious adverse reactions may affect the neurologic and cardiovascular systems. 3,4 With the increasing use of ICIs, clinicians should be knowledgeable about these adverse reactions, which are graded from 1 (mild) to 4 (life-threatening). This article describes the clinical presentation and management of ICI-induced adverse reactions (Table 1). DERMATOLOGIC TOXICITYDermatologic toxicities are the most prevalent and often the earliest adverse reaction, and are reported in 30% to 50% of patients treated with ICIs. 5 These toxicities occur