Nephrotoxicity in CAR-T Cell Therapy.

Area of Science:

• Oncology
• Immunology
• Nephrology

Background:

• Chimeric antigen receptor (CAR)-T cell therapy offers a promising treatment for hematologic malignancies.
• CAR-T cell therapy is known for significant toxicities like cytokine release syndrome (CRS) and neurotoxicity.
• Nephrotoxicity is an emerging concern with CAR-T cell therapy, receiving less attention to date.

Purpose of the Study:

• To review the incidence and association between CAR-T cell therapy and kidney injury.
• To elucidate risk factors, biomarkers, and potential mechanisms of acute kidney injury (AKI) and chronic kidney disease (CKD) following CAR-T cell therapy.
• To explore the impact of nephrotoxicity on CAR-T cell efficacy and the safety of lymphodepletion in patients with pre-existing kidney conditions.

Main Methods:

• Literature review focusing on CAR-T cell therapy and renal impairment.
• Analysis of reported cases and studies on CAR-T cell-associated nephrotoxicity.
• Synthesis of information on risk factors, biomarkers, pathomechanisms, and clinical outcomes.

Main Results:

• CAR-T cell therapy is associated with varying degrees of kidney injury, including AKI and CKD.
• Identified risk factors and potential biomarkers for predicting and monitoring CAR-T cell-induced nephrotoxicity.
• Explored the link between renal impairment and other CAR-T cell toxicities, as well as its effect on therapeutic efficacy.

Conclusions:

• Kidney injury is a significant, albeit under-recognized, toxicity of CAR-T cell therapy.
• Understanding nephrotoxicity mechanisms is crucial for improving patient safety and treatment outcomes.
• Further research is needed to optimize management strategies for CAR-T cell therapy in patients with kidney compromise.