Key clinical point: Acute kidney injury occurred in 19% of DLBCL patients receiving CAR-T therapy.

Major finding: Cytokine release syndrome occurred in 85% of patients receiving CAR-T therapy.

Study details: A review of 78 adult DLBCL patients receiving CAR-T therapy at 2 major cancer centers.

Disclosures: The study did was funded by National Institutes of Health grants. The authors reported relationships with various pharmaceutical companies.

Commentary

Chimeric antigen receptor (CAR) T-cell therapy is a novel strategy approved for relapsed/refractory diffuse large B-cell lymphoma (DLBCL) patients. While cytokine release syndrome (CRS) is a well described phenomenon occurring after administration of CAR T-cells, few studies have focused on other toxicities including acute kidney injury (AKI). This retrospective review of 78 DLBCL patients who received CAR T-cells found that 85% had CRS and 15/78 had AKI. AKI was 9.8 times more common in those with higher grade compared with lower grade CRS. The mechanism of AKI varied with decreased perfusion and acute tubular necrosis (ATN) as most common, and there were resulting electrolyte abnormalities in over half. Patients with ATN or obstruction had worse outcomes than those with decreased perfusion, and the 3 requiring hemodialysis ultimately died within 30 days of receiving CAR T-cells. This report adds to the growing body of literature on toxicity of CAR T-cells.—Sarah Rutherford, MD