Acute Kidney Injury Following Chimeric Antigen Receptor T-Cell Therapy for B-Cell Lymphoma in a Kidney Transplant Recipient.
Acute Kidney Injury Following Chimeric Antigen Receptor T-Cell Therapy for B-Cell Lymphoma in a Kidney Transplant Recipient.
复制标题
DOI：
10.1016/j.xkme.2021.03.011
复制
发表时间：
2021-07
期刊：
影响因子：
3.9
通讯作者：
Bestard O
中科院分区：
文献类型：
--
作者：
Melilli E;Mussetti A;Linares GS;Ruella M;La Salette C;Savchenko A;Taco MDR;Montero N;Grinyo J;Fava A;Gomà M;Meneghini M;Manonelles A;Cruzado J;Sureda A;Bestard O
抗CD19嵌合抗原受体（CAR）T细胞疗法是一种较新且有效的治疗选择，已被批准用于复发/难治性急性淋巴细胞白血病和弥漫性大B细胞淋巴瘤患者。急性肾损伤是 CAR T 细胞治疗的一种并发症，可能导致肾衰竭。在大多数情况下，它被认为与细胞因子释放综合征导致的血流动力学变化有关。在这种临床情况下通常不进行肾活检。我们报道了一位 40 多岁的肾移植受者，他患有传统治疗难治的 B 细胞来源的移植后淋巴增殖性疾病，并接受了抗 CD19 CAR T 细胞疗法作为同情治疗。从 CAR T 细胞输注后第 12 天开始，在没有临床症状的情况下，肾移植物的估计肾小球滤过率出现逐渐下降。随后的同种异体移植活检显示轻度肾小管间质淋巴细胞浸润，属于班夫边界变化类别，类似于急性免疫过敏性肾小管间质性肾炎。在移植细胞浸润内未检测到 CAR T 细胞和淋巴瘤 B 细胞，这表明肾损伤的间接机制。尽管类固醇治疗后肾移植功能部分恢复，但移植后淋巴增殖性疾病进展，患者于 7 个月后死亡。
Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is a newer and effective therapeutic option approved for patients with relapsed/refractory acute lymphoblastic leukemia and diffuse large B-cell lymphoma. Acute kidney injury is a complication of CAR T-cell therapy that can result in kidney failure. In most cases, it is thought to be related to hemodynamic changes due to cytokine release syndrome. Kidney biopsy in this clinical scenario is usually not performed. We report on a kidney transplant recipient in his 40s who developed a posttransplant lymphoproliferative disorder of B-cell origin refractory to conventional treatments and received anti-CD19 CAR T-cell therapy as compassionate treatment. Beginning on day 12 after CAR T-cell infusion, in the absence of clinical symptoms, a progressive decline in estimated glomerular filtration rate of the kidney graft occurred. A subsequent allograft biopsy showed mild tubulointerstitial lymphocyte infiltrates, falling into a Banff borderline-changes category and resembling an acute immunoallergic tubulointerstitial nephritis. Neither CAR T cells nor lymphomatous B cells were detected within the graft cellular infiltrates, suggesting an indirect mechanism of kidney injury. Although kidney graft function partially recovered after steroid therapy, the posttransplant lymphoproliferative disorder progressed and the patient died 7 months later.
登录
查看更多内容
DOI：
10.1038/nrclinonc.2017.148
发表时间：
2018-01
期刊：
Nature reviews. Clinical oncology
影响因子：
--
作者：
Neelapu SS;Tummala S;Kebriaei P;Wierda W;Gutierrez C;Locke FL;Komanduri KV;Lin Y;Jain N;Daver N;Westin J;Gulbis AM;Loghin ME;de Groot JF;Adkins S;Davis SE;Rezvani K;Hwu P;Shpall EJ
通讯作者：
Shpall EJ
影响因子：
13.2
作者：
Gupta, Shruti;Seethapathy, Harish;Sise, Meghan E.
通讯作者：
Sise, Meghan E.
DOI：
10.2215/cjn.00990119
发表时间：
2019-12-06
影响因子：
9.8
作者：
Seethapathy, Harish;Zhao, Sophia;Sise, Meghan E.
通讯作者：
Sise, Meghan E.
影响因子：
158.5
作者：
Schuster, Stephen J.;Bishop, Michael R.;Maziarz, Richard T.
通讯作者：
Maziarz, Richard T.
影响因子：
8.8
作者：
Opelz, G;Döhle, B
通讯作者：
Döhle, B