Outcomes of CD19-Targeted Chimeric Antigen Receptor T Cell Therapy for Patients with Reduced Renal Function Including Dialysis

Wood, Anthony C.; Perez, Ariel Perez; Arciola, Brian; Patel, Kedar; Johnson, Grace; DiMaggio, Elizabeth; Bachmeier, Christina A.; Reid, Kayla; Carallo, Salvatore; Vargas, Melanie H.; Faramand, Rawan; Chávez, Julio C.; Shah, Bijal; Gaballa, Sameh; Khimani, Farhad; Elmariah, Hany; Nishihori, Taiga; Lazaryan, Aleksandr; Freeman, Ciara L.; Davila, Marco L.; Locke, Frederick L.; Mhaskar, Rahul; Bassil, Claude; Jain, Michael D.

doi:10.1016/j.jtct.2022.09.009

Cited by 13 publications

(18 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…observed comparable outcomes related to toxicity, disease response and survival between the groups with RKF and NKF irrespective of eGFR value. Similar findings highlighting the impact of RKF on CAR T-cell toxicity and survival were reported in three other studies involving axi-cel (with/ without tisa-cel and brexu-cel) and in one study involving liso-cel 5,6,8,12 (Table 3).…”

supporting

confidence: 86%

“…These findings support the growing evidence that post CAR T-cell AKI, irrespective of baseline kidney function, is a prevalent complication that is predominantly mild in severity and has favourable kidney outcome. [8][9][10][11] To our knowledge, this is the largest study reporting the outcomes of patients who would be ineligible to participate in CAR T clinical trials on the basis of kidney function. We T A B L E 1 Patient baseline and disease characteristics and their association with the status of the kidney function at the time of lymphodepleting chemotherapy.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Real‐world analysis of safety and efficacy of CAR T‐cell therapy in lymphoma patients with decreased kidney function

Mamlouk,

Strati,

Feng

et al. 2023

Br J Haematol

View full text Add to dashboard Cite

supporting

confidence: 86%

mentioning

confidence: 99%

Real‐world analysis of safety and efficacy of CAR T‐cell therapy in lymphoma patients with decreased kidney function

Mamlouk,

Strati,

Feng

et al. 2023

Br J Haematol

View full text Add to dashboard Cite

“…with previously normal renal function [33]. Thus, lymphodepletion dosing regimens can be personalized to avoid renal failure without compromising eligibility or response to CAR-T cell therapy.…”

Section: Discussionmentioning

confidence: 99%

Safety of CAR-T Cell Therapy in Patients With Renal Failure/Acute Kidney Injury: Focused Review

Khan¹,

Khan

Wolfson

et al. 2023

Clin Hematol Int

View full text Add to dashboard Cite

Chimeric antigen receptor (CAR) T-cell therapy is novel immunotherapy targeting specifically cancerous cells, and has been shown to induce durable remissions in some refractory hematological malignancies. However, CAR T-cell therapy has adverse effects, such as cytokine release syndrome (CRS), immune effector-associated neurotoxicity syndrome (ICANS), tumor lysis syndrome (TLS), and acute kidney injury (AKI), among others. Not many studies have covered the repercussions of CAR T-cell therapy on the kidneys. In this review, we summarized the available evidence on the safety profile of CAR T-cell therapy in patients with pre-existing renal insufficiency/AKI and in those who develop AKI as a result of CAR T-cell therapy. With a 30% incidence of AKI post-CAR T-cell, various pathophysiological mechanisms, such as CRS, hemophagocytic lymphohistiocytosis (HLH), TLS, serum cytokines, and inflammatory biomarkers, have been shown to play a role. However, CRS is commonly reported as an underlying mechanism. Overall, 18% of patients in our included studies developed AKI after receiving CAR T-cell therapy, and most cases were reversible with appropriate therapy. While phase-1 clinical trials exclude patients with significant renal toxicity, two studies (Mamlouk et al. and Hunter et al.) reported successful treatment of dialysis-dependent patients with refractory diffuse large B-cell lymphoma, and demonstrated that CAR T-cell therapy and lymphodepletion (Flu/Cy) can be safely administered.

show abstract

“…Most recently, a retrospective, single-center cohort study ( n = 166) evaluated the outcomes of patients with kidney impairment (defined as eGFR of <60 mL/min/1.73 m 2 by the Modification of Diet in Renal Disease equation using day −5 Cr level at the initiation of lymphodepletion) ( n = 17) receiving CAR-T for relapsed/refractory DLBCL. 11 The incidence of any Grade AKI (defined by KDIGO criteria) was higher in those with kidney impairment, 42% versus 21% ( p = 0.08). However, only two patients had pre-CAR-T ESKD on HD, and both received tisagenlecleucel for relapsed/refractory DLBCL.…”

Section: Discussionmentioning

confidence: 89%

Chimeric antigen receptor T-cell therapy in a dialysis patient with lymphoma

Mire

Collins

Bonilla

et al. 2023

Journal of Onco-Nephrology

View full text Add to dashboard Cite

Chimeric antigen receptor T-cell (CAR-T) therapy has become a revolutionary cancer therapy for multiple subtypes of hematologic malignancies. Despite this progress, CAR-T use in End Stage Kidney Disease (ESKD) patients is limited. We describe the successful administration of CAR-T therapy in a patient with ESKD who had developed diffuse large B-cell lymphoma (DLBCL) from an underlying chronic lymphocytic leukemia. The patient received CAR-T therapy, preceded by lymphodepleting chemotherapy with dose-reduced fludarabine and cyclophosphamide, followed by intermittent hemodialysis on a modified basis. The treatment course was complicated by pancytopenia and Grade 2 cytokine release syndrome, managed with tocilizumab. The patient underwent an initial disease response assessment, which showed a complete response, and remains in remission 12 months after CAR-T infusion. This case report highlights the importance of individualized hemodialysis schedules and lymphodepleting chemotherapy dose adjustments in ESKD patients for a successful administration of CAR-T therapy.

show abstract

Outcomes of CD19-Targeted Chimeric Antigen Receptor T Cell Therapy for Patients with Reduced Renal Function Including Dialysis

Cited by 13 publications

References 27 publications

Real‐world analysis of safety and efficacy of CAR T‐cell therapy in lymphoma patients with decreased kidney function

Real‐world analysis of safety and efficacy of CAR T‐cell therapy in lymphoma patients with decreased kidney function

Safety of CAR-T Cell Therapy in Patients With Renal Failure/Acute Kidney Injury: Focused Review

Chimeric antigen receptor T-cell therapy in a dialysis patient with lymphoma

Contact Info

Product

Resources

About