Abstract: FR-PO258
Chimeric Antigen Receptor T-Cell Therapy in a Dialysis Patient with Lymphoma
Session Information
- Onconephrology: From AKI to CKD and Everything in Between
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Mire, Muhammad, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
- Koyner, Jay L., University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
- Bonilla Arevalo, Marco Antonio, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
- Collins, Jennifer, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
- Riedell, Peter, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
Introduction
Chimeric antigen receptor T-cell (CAR-T) therapy has become a revolutionary cancer therapy for multiple subtypes of hematologic malignancies. Despite this, CAR-T use in End Stage Kidney Disease (ESKD) patients is limited. We describe the successful administration of CAR-T therapy in a patient with ESKD.
Case Description
A 60-year-old female with a history of hypertension, heart failure, ESKD on hemodialysis (HD), and diffuse large B cell lymphoma (DLBCL) from an underlying chronic lymphocytic leukemia (CLL) was admitted for CAR-T therapy. Prior to the receipt of CAR-T, she received three days of lymphodepleting chemotherapy consisting of Cyclophosphamide (660 mg/24 hours) and dose-reduced fludarabine(20 mg/m2). During this regimen, she underwent HD on 3 consecutive days, approximately 12 hours after her fludarabine infusions. Following CAR-T infusion, the patient resumed her traditional 3 times per week HD schedule. The patient’s course was complicated by pancytopenia, lasting for 13 days. The patient experienced Grade 2 cytokine release syndrome (CRS), and was treated with one dose of tocilizumab on Day 11 post CAR-T. At the time of the last follow-up, the patient remains with ESKD on HD, and is still in remission 12 months after CAR-T.
Discussion
When performing HD, timing is essential to limit toxicity and minimize drug removal prior to CAR-T infusion, while also not eliminating the drug prior to its distribution and onset of action. Given the uncertainties of HD timing, drug removal, and the apparent increased risk of complications, further investigations are needed to determine the ideal treatment strategies in patients with ESKD. Future efforts to elucidate the impact of lymphodepleting chemotherapy on cytokine profiles and other factors in patients with ESKD will help inform management strategies. Collaborative efforts and standardized protocols are needed to better define the optimal HD timing in CAR-T recipients.