Acute kidney injury in hematological patients treated with CAR-T cells: risk factors, clinical presentation and impact on outcomes
Abstract Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment of hematologic malignancies, yet it carries significant risks, including acute kidney injury (AKI). In this study, we investigated the risk factors and clinical impact of AKI in patients undergoing CAR-T cell...
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Nature Portfolio
2024-11-01
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| Online Access: | https://doi.org/10.1038/s41598-024-77720-z |
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| author | Elisa Russo Massimiliano Gambella Anna Maria Raiola Elena Beltrametti Valentina Zanetti Giuseppe Chirco Francesca Viazzi Emanuele Angelucci Pasquale Esposito |
| author_facet | Elisa Russo Massimiliano Gambella Anna Maria Raiola Elena Beltrametti Valentina Zanetti Giuseppe Chirco Francesca Viazzi Emanuele Angelucci Pasquale Esposito |
| author_sort | Elisa Russo |
| collection | DOAJ |
| description | Abstract Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment of hematologic malignancies, yet it carries significant risks, including acute kidney injury (AKI). In this study, we investigated the risk factors and clinical impact of AKI in patients undergoing CAR-T cell therapy. This retrospective study involved hematologic patients treated with CAR-T therapy. Clinical and laboratory data were collected, and clinical outcomes were monitored during follow-up after CAR-T infusion. AKI was defined according to KDIGO criteria. The outcome measures included early mortality, overall survival (OS), and disease-free survival (DFS). Among the 48 patients analyzed, 14 (29%) developed AKI, with a mean onset of 6 days after CAR-T infusion. The risk of AKI was associated with baseline performance status (OR 8.65, IC95% 6.2–12, p = 0.032) and the development of severe cytokine release syndrome post-therapy (OR 16.4 95%CI 1.9-138.5, p = 0.01). Patients with AKI more frequently required intensive care. Furthermore, severe AKI was independently associated with worse clinical outcomes, including reduced OS and DFS (HR 18.2, 95%CI 2.6–27.3, p = 0.003). Additionally, patients who developed AKI post-CAR-T therapy were more likely to progress to chronic kidney disease during follow-up. In conclusion, frail patients undergoing CAR-T therapy are at an increased risk of developing AKI, which can significantly affect both short- and long-term outcomes. Preventive strategies and early recognition of AKI are essential in these patients. |
| format | Article |
| id | doaj-art-6f8a1ee9b08b477eb92a55a9a8bf549b |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-6f8a1ee9b08b477eb92a55a9a8bf549b2024-11-10T12:18:17ZengNature PortfolioScientific Reports2045-23222024-11-0114111010.1038/s41598-024-77720-zAcute kidney injury in hematological patients treated with CAR-T cells: risk factors, clinical presentation and impact on outcomesElisa Russo0Massimiliano Gambella1Anna Maria Raiola2Elena Beltrametti3Valentina Zanetti4Giuseppe Chirco5Francesca Viazzi6Emanuele Angelucci7Pasquale Esposito8Department of Internal Medicine and Medical Specialties (DIMI), University of GenovaUnit of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San MartinoUnit of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San MartinoDepartment of Internal Medicine and Medical Specialties (DIMI), University of GenovaDepartment of Internal Medicine and Medical Specialties (DIMI), University of GenovaUnit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San MartinoDepartment of Internal Medicine and Medical Specialties (DIMI), University of GenovaUnit of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San MartinoDepartment of Internal Medicine and Medical Specialties (DIMI), University of GenovaAbstract Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment of hematologic malignancies, yet it carries significant risks, including acute kidney injury (AKI). In this study, we investigated the risk factors and clinical impact of AKI in patients undergoing CAR-T cell therapy. This retrospective study involved hematologic patients treated with CAR-T therapy. Clinical and laboratory data were collected, and clinical outcomes were monitored during follow-up after CAR-T infusion. AKI was defined according to KDIGO criteria. The outcome measures included early mortality, overall survival (OS), and disease-free survival (DFS). Among the 48 patients analyzed, 14 (29%) developed AKI, with a mean onset of 6 days after CAR-T infusion. The risk of AKI was associated with baseline performance status (OR 8.65, IC95% 6.2–12, p = 0.032) and the development of severe cytokine release syndrome post-therapy (OR 16.4 95%CI 1.9-138.5, p = 0.01). Patients with AKI more frequently required intensive care. Furthermore, severe AKI was independently associated with worse clinical outcomes, including reduced OS and DFS (HR 18.2, 95%CI 2.6–27.3, p = 0.003). Additionally, patients who developed AKI post-CAR-T therapy were more likely to progress to chronic kidney disease during follow-up. In conclusion, frail patients undergoing CAR-T therapy are at an increased risk of developing AKI, which can significantly affect both short- and long-term outcomes. Preventive strategies and early recognition of AKI are essential in these patients.https://doi.org/10.1038/s41598-024-77720-zAcute kidney injuryPerformance statusCAR-T cell therapyCytokine release syndromeDisease-free survivalMortality |
| spellingShingle | Elisa Russo Massimiliano Gambella Anna Maria Raiola Elena Beltrametti Valentina Zanetti Giuseppe Chirco Francesca Viazzi Emanuele Angelucci Pasquale Esposito Acute kidney injury in hematological patients treated with CAR-T cells: risk factors, clinical presentation and impact on outcomes Scientific Reports Acute kidney injury Performance status CAR-T cell therapy Cytokine release syndrome Disease-free survival Mortality |
| title | Acute kidney injury in hematological patients treated with CAR-T cells: risk factors, clinical presentation and impact on outcomes |
| title_full | Acute kidney injury in hematological patients treated with CAR-T cells: risk factors, clinical presentation and impact on outcomes |
| title_fullStr | Acute kidney injury in hematological patients treated with CAR-T cells: risk factors, clinical presentation and impact on outcomes |
| title_full_unstemmed | Acute kidney injury in hematological patients treated with CAR-T cells: risk factors, clinical presentation and impact on outcomes |
| title_short | Acute kidney injury in hematological patients treated with CAR-T cells: risk factors, clinical presentation and impact on outcomes |
| title_sort | acute kidney injury in hematological patients treated with car t cells risk factors clinical presentation and impact on outcomes |
| topic | Acute kidney injury Performance status CAR-T cell therapy Cytokine release syndrome Disease-free survival Mortality |
| url | https://doi.org/10.1038/s41598-024-77720-z |
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