CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
CAR-T 细胞治疗受者的急性肾损伤：临床特征及对死亡率的影响
英文原题：Acute Kidney Injury in Recipients of Chimeric Antigen Receptor T-Cell therapy: Clinical Characteristics and Impact on Mortality.
查看英文原题
Acute Kidney Injury in Recipients of Chimeric Antigen Receptor T-Cell therapy: Clinical Characteristics and Impact on Mortality.
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中文摘要
CAR-T 细胞疗法是血液系统恶性肿瘤治疗的突破性进展，但伴随风险，包括急性肾损伤（AKI）。AKI可能由细胞因子释放综合征（CRS）等炎症反应引起，后者影响肾脏灌注。
本研究旨在报告接受CAR-T 治疗患者中AKI的发生率、特征及潜在相关因素。本回顾性研究分析了186例接受CAR-T 治疗的患者，评估CAR-T 产品输注后100天内AKI的发生率、发生时间、严重程度及相关危险因素。AKI依据KDIGO标准定义。CRS依据美国移植与细胞治疗学会标准进行分级。在186例患者中（103例多发性骨髓瘤（MM），75例非霍奇金淋巴瘤（NHL），8例白血病），34%发生AKI（95% CI：27%至40.7%），各癌种间发生率相似。大多数病例（77.8%）发生在输注后三周内。AKI在非裔美国人个体中更为常见（57.7%，P = .015），且与年龄较大相关（中位年龄67岁对62岁，P = .003）。合并CKD的患者更易发生AKI（50.8%对25.6%，P < .001）。总体CRS发生率为82.8%（95% CI：76.7%至87.5%），其中35.1%发生AKI，但与无CRS者相比未发现统计学显著性。
CRS级别越高，AKI发生率越高（1级 = 33.9%；2级 = 37.9%，3级 = 42.9%，P = .83）。大多数AKI发作为1级（69.8%）且可逆；71.4%恢复至基线肾功能，而28.6%未恢复，2例在100天内死亡，1例需要透析。既往有AKI的患者输注后AKI常见（50.8%）（P < .001）。与无AKI者相比，AKI与死亡风险增加2.6倍相关（OR 2.57，P = .019）。在调整年龄、性别、CRS、ICANS和恶性肿瘤类型后，AKI与死亡率增加独立相关（调整后HR：2.59，95% CI：1.33至5.04）。AKI是CAR-T 治疗中常见且早期的并发症，尤其在非裔美国患者、老年人、CKD患者及有AKI既往史者中。虽然大多数病例为轻度且可逆，但识别高风险患者可能有助于加强监测、支持治疗和早期干预。
展开英文摘要原文
Chimeric antigen receptor T-cell (CAR-T) therapy is a breakthrough in hematologic malignancies but carries risks, including acute kidney injury (AKI). AKI may arise due to inflammatory responses like cytokine release syndrome (CRS), which affects renal perfusion.
This study is intended to report on the incidence and characteristics of AKI and potential associated factors in patients receiving CAR-T therapy. This retrospective study analyzed 186 patients treated with CAR-T therapy, assessing AKI incidence, timing, severity, and associated risk factors within 100 days postinfusion of CAR-T product. AKI was defined by KDIGO criteria. CRS was graded based on the criteria of the American Society of Transplantation and Cellular Therapy.
Among 186 patients (103 with multiple myeloma (MM), 75 with non-Hodgkin Lymphoma (NHL), and 8 with leukemia), 34% developed AKI (95% CI: 27% to 40. 7%) with similar incidence by cancer type. Most cases (77. 8%) occurred within three weeks of postinfusion. AKI was more common among African American individuals (57. 7%, P = . 015) and with older age (median 67 versus 62 years, P = . 003). Patients with CKD were more likely to have AKI (50. 8% versus 25. 6%, P < . 001).
Overall CRS incidence was 82. 8% (95% CI: 76. 7% to 87. 5%) , and 35. 1% had AKI although no statistical significance found when compared to those without CRS. Higher grades of CRS had higher incidence of AKI (Grade 1 = 33. 9%; Grade 2 = 37. 9%, Grade 3 = 42. 9%, P = . 83) Most AKI episodes were Grade 1 (69. 8%) and reversible; 71. 4% recovered baseline kidney function, while 28. 6% did not, two died within 100 days, 1 required dialysis. AKI postinfusion was common among patients with prior AKI (50. 8%) (P < . 001). AKI was associated 2.
6 times higher odds of death compared to those without AKI (OR 2. 57, P = . 019). After adjusting for age, sex, CRS, ICANS, and malignancy type, AKI was independently associated with increased mortality (adjusted HR: 2. 59, 95% CI: 1. 33 to 5. 04). AKI is a frequent and early complication of CAR-T therapy, particularly among African American patients, older individuals, those with CKD and prior history of AKI. While most cases are mild and reversible, identifying high-risk patients may enhance monitoring, supportive care, and early intervention.
论文信息
- 作者
- Jazieh H、Almashayekh A、Henson JC、Omaish R、Spears G、Vellanki S、Trikannad A、Daughdrill B
- 第一作者单位
- Faculty of Medicine, University of Blida, Blida, 09068, Algeria.
- 通讯作者单位
- Department of Nephrology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, US. Electronic address: abd0badwan@gmail.com.
- 期刊
- Transplantation and cellular therapy2026 Jul 22
- 原文标识
- PubMed 42486353 · DOI 10.1016/j.jtct.2026.07.019