Chimeric antigen receptor (CAR) T cell therapy using engineered cytotoxic T cells has shown promising responses in various hematological malignancies. Cytokine release syndrome (CRS) and immune effector cell associated neurological syndrome (ICANS) are recognized toxicities of CAR-T, while kidney injury remains less recognized. The objective of this study was to identify the incidence of acute kidney injury (AKI) post CAR-T cell therapy, potential risk factors, and kidney function recovery. We performed a retrospective review of 46 adult patients with Non-Hodgkin lymphoma treated with CAR-T therapy from February 2018 to February 2019 at our institution. Serum creatinine values prior to CAR-T therapy through day 100 were used to assess AKI, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria: grade 1 (1.5 - < 2-fold), grade 2 (2 - < 3-fold), and grade 3 (≥ 3-fold) baseline. CRS and ICANS were graded using the consensus criteria by the American Society of Transplantation and Cellular Therapy. The overall incidence of CRS was 78.3% (95% CI 66-90.5%) of which 13% (95% CI 3.3-22.8%) developed grade 3-4 CRS, while overall incidence of ICANS was lower at 45.7% (95% CI 3.1-60.3%). The cumulative incidence of any grade AKI by day 100 was 30% (95%CI 16.9-43.9%) with grade 1 AKI incidence at 21.7% (95%CI 9.7-33.8%) and grade 2-3 AKI incidence at 8.7% (95%CI: 0.4-17%). None of the patients developed severe AKI requiring renal replacement therapy. Patients with prior autologous or allogeneic stem cell transplantation, those requiring intensive care unit level care and with grade 3-4 CRS had a higher incidence of AKI. Most patients recovered with kidney function returning to baseline within 30 days. We conclude that with early recognition and management of CAR-T complications, the incidence of AKI is low, the severity of injury is mild, and most patients recover kidney function within 30 days.

中文翻译：

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CAR-T 细胞治疗后的急性肾损伤：低发生率和快速恢复。

使用工程细胞毒性 T 细胞的嵌合抗原受体 (CAR) T 细胞疗法已在各种血液恶性肿瘤中显示出有希望的反应。细胞因子释放综合征 (CRS) 和免疫效应细胞相关神经系统综合征 (ICANS) 是公认的 CAR-T 毒性，而对肾损伤的认识仍然较少。本研究的目的是确定 CAR-T 细胞治疗后急性肾损伤 (AKI) 的发生率、潜在危险因素和肾功能恢复情况。我们对 2018 年 2 月至 2019 年 2 月在我们机构接受 CAR-T 治疗的 46 名成人非霍奇金淋巴瘤患者进行了回顾性研究。CAR-T 治疗前至第 100 天的血清肌酐值用于评估 AKI，如肾脏疾病改善全球结果 (KDIGO) 标准所定义：1 级（1.5 - < 2 倍），2 级（2 - < 3 倍）和 3 级（≥ 3 倍）基线。CRS 和 ICNS 使用美国移植和细胞治疗学会的共识标准进行分级。CRS 的总发病率为 78.3% (95% CI 66-90.5%)，其中 13% (95% CI 3.3-22.8%) 发展为 3-4 级 CRS，而 ICNS 的总发病率较低，为 45.7% (95% CI 3.1-60.3%）。到第 100 天，任何级别 AKI 的累积发生率为 30%（95%CI 16.9-43.9%），其中 1 级 AKI 发生率为 21.7%（95%CI 9.7-33.8%），2-3 级 AKI 发生率为 8.7%（ 95% CI：0.4-17%）。没有患者出现需要肾脏替代治疗的严重 AKI。既往接受过自体或同种异体干细胞移植的患者、需要重症监护室级别护理和 3-4 级 CRS 的患者 AKI 发生率较高。大多数患者在 30 天内肾功能恢复到基线水平。我们得出结论，通过早期识别和处理 CAR-T 并发症，AKI 的发生率低，损伤程度轻，大多数患者在 30 天内恢复肾功能。