Incidence and Risk Factors for Acute Kidney Injury After Chimeric Antigen Receptor T-Cell Therapy

Naba Farooqui, Janina Paula T. Sy-Go, Jing Miao, Ramila Mehta, Lisa E. Vaughan, N. Nora Bennani, Yucai Wang, Radhika Bansal, Matthew A. Hathcock, Suzanne R. Hayman, Patrick B. Johnston, Jose C. Villasboas, Jonas Paludo, Stephen M. Ansell, Nelson Leung, Yi Lin, Sandra M. Herrmann

Research output: Contribution to journalArticlepeer-review


Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1294-1304
Number of pages11
JournalMayo Clinic proceedings
Issue number7
StatePublished - Jul 2022

ASJC Scopus subject areas

  • Medicine(all)


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