医学
急性肾损伤
内科学
肌酸激酶
肌酐
肾功能
肿瘤溶解综合征
乳酸脱氢酶
胃肠病学
入射(几何)
淋巴瘤
托珠单抗
泌尿科
化疗
生物化学
化学
物理
疾病
光学
酶
作者
Naba Farooqui,Janina Paula T. Sy-Go,Jing Miao,Ramila A. Mehta,Lisa E. Vaughan,N. Nora Bennani,Yucai Wang,Radhika Bansal,Matthew Hathcock,Suzanne R. Hayman,Patrick B. Johnston,José C. Villasboas,Jonas Paludo,Stephen M. Ansell,Nelson Leung,Yi Lin,Sandra M. Herrmann
标识
DOI:10.1016/j.mayocp.2022.05.018
摘要
To evaluate the association of baseline and postinfusion patient characteristics with acute kidney injury (AKI) in the month after chimeric antigen receptor T-cell (CAR-T) therapy.We retrospectively reviewed records of 83 patients with non-Hodgkin lymphoma undergoing CAR-T therapy (axicabtagene ciloleucel) between June 2016 and November 2020. Patients were followed up to 1 month after treatment. Post-CAR-T AKI was defined as a more than 1.5-fold increase in serum creatinine concentration from baseline (on the day of CAR-T infusion) at any time up to 1 month after CAR-T therapy.Of 83 patients, 14 (17%) developed AKI during follow-up. At 1 month after CAR-T infusion, 10 of 14 (71%) AKI events had resolved. Lower baseline estimated glomerular filtration rate, use of intravenous contrast material, tumor lysis prophylaxis, higher peak uric acid and creatine kinase levels during follow-up, and change in lactate dehydrogenase from baseline to peak level within 1 month after initiation of CAR-T therapy were significantly associated with AKI incidence during follow-up. Incidence of AKI was also higher in patients who received higher doses of corticosteroids and tocilizumab.Acute kidney injury occurred in approximately 1 in 6 patients who received axicabtagene ciloleucel for non-Hodgkin lymphoma. Patients with high tumor burden receiving higher total doses of corticosteroids or tocilizumab should be closely monitored for development of AKI. Lower baseline kidney function at CAR-T initiation, exposure to contrast material, and progressive increase in levels of tumor lysis markers (uric acid, lactate dehydrogenase, creatine kinase) after CAR-T infusion may predict risk of AKI during the 1 month after infusion.
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