Abstract
Baseline risk factors for acute kidney injury (AKI) during chimeric antigen receptor T-cell (CAR-T) therapy are not well described. Hence, we evaluated the incidence and risk factors associated with AKI among patients undergoing CAR-T for relapsed/refractory large B-cell lymphoma. Among 155 patients, 28 (18%) developed AKI with a median time-to-peak creatinine from CAR-T of 9.5 days (range = 3-30). Aetiologies included volume depletion (n = 20, 71%), cytokine release syndrome (n = 5, 18%), nephrotoxins (n = 5, 18%), tumour lysis syndrome (n = 1, 4%) and multifactorial (n = 6, 21%). On univariable analysis, a history of chronic kidney disease (CKD) relative risk (RR 3.5, 95% CI: 1.9-6.6, p < 0.01), receipt of axicabtagene ciloleucel (RR 2.1, 95% CI: 1.1-4.2, p = 0.04), elevated ferritin (RR 3.1, 95% CI: 1.1-8.4, p = 0.03) and serum creatinine level (RR 2.9, 95% CI: 1.4-6.2, p < 0.01) were associated with AKI. On multivariable analysis, a history of CKD adjusted relative risk (aRR 3.5, 95% CI: 1.9-6.4, p < 0.01) and receipt of axicabtagene ciloleucel (aRR 2.1, 95% CI: 1.1-4.0, p = 0.03) retained statistical significance. Four (2.6%) patients required renal replacement therapy during CAR-T. Twenty-five of 28 patients with AKI had renal recovery with a median time to recovery of 14 days (range = 5-85). Of those without renal recovery, two required long-term haemodialysis and one experienced disease progression and died 34 days after CAR-T. Patients with AKI had shorter median PFS (2.4 vs. 6.9 months, p = 0.02) and OS (7.8 vs. 29.7 months, p < 0.01). Additional research is needed to obviate the risk of renal toxicity and improve post-CAR-T outcomes.