Successful administration of chimeric antigen receptor (CAR) T-cell therapy in patients requiring hemodialysis
Tóm tắt
Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of relapsed/refractory B-cell malignancies. However, there is no data on the safety and efficacy of CAR T-cell therapy in patients with end stage renal disease (ESRD) requiring dialysis. In this report, we present two patients with DLBCL and ESRD who were successfully treated with different CAR T-cell products. Patient #1 is a 66 year-old woman with a history of HIV who was treated to complete response with axicabtagene ciloleucel with treatment complicated by grade 1 cytokine release syndrome (CRS) and grade 2 immune effector cell-associated neurolotoxicity syndrome (ICANS). Patient #2 is 52 year old woman whose ESRD was caused by ifosphamide toxicity and was treated to complete response with lisocabtagene maraleucel and did not experience either CRS or ICANS. Both patients received lymphodepletion chemotherapy with fludarabine and cyclophosphamide, which was dose-adjusted for ESRD with scheduled dialysis 12 h after each dose of lymphodepletion chemotherapy. Patients with DLBCL and ESRD can be safely administered both lymphodepletion chemotherapy and CAR T-cell therapy. Additionally, the fact that both patients achieved complete response to therapy suggests that CAR T-cell therapy should be strongly considered in patients with ESRD. Long-term follow up is needed to determine if therapy in this setting is of curative intent.
Tài liệu tham khảo
Crump M, Neelapu SS, Farooq U, et al. Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study. Blood. 2017;130(16):1800–8.
Jacobson CA, Hunter BD, Redd R, et al. Axicabtagene ciloleucel in the non-trial setting: outcomes and correlates of response, resistance, and toxicity. J Clin Oncol. 2020;38(27):3095–106.
Neelapu SS, Locke FL, Bartlett NL, et al. Axicabtagene ciloleucel CAR T-Cell therapy in refractory large B-Cell lymphoma. N Engl J Med. 2017;377(26):2531–44.
Abramson JS, Palomba ML, Gordon LI, et al. Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): a multicentre seamless design study. Lancet. 2020;396(10254):839–52.
Jacobson C, Locke FL, Ghobadi A, et al. Long-term survival and gradual recovery of B Cells in patients with refractory large B Cell lymphoma treated with axicabtagene ciloleucel (Axi-Cel). Blood. 2020;136(Supplement 1):40–2.
Adkins JC, Peters DH, Markham A. Fludarabine. An update of its pharmacology and use in the treatment of haematological malignancies. Drugs. 1997;53(6):1005–37.
Eyquem J, Hamieh M, Piersigilli A, et al. Fludarabine and neurotoxicity in engineered T-cell therapy. Nat Med. 2018;25(3):176–91.
Merkel DE, Griffin NL, Kagan-Hallet K, Von Hoff DD. Central nervous system toxicity with fludarabine. Cancer Treat Rep. 1986;70(12):1449–50.
Winter SF, Martinez-Lage M, Clement NF, Hochberg EP, Dietrich J. Fatal neurotoxicity after chimeric antigen receptor T-cell therapy: an unexpected case of fludarabine-associated progressive leukoencephalopathy. Eur J Cancer. 2021;144:178–81.
Chen YB, Elias N. Haploidentical hematopoietic cell and kidney transplantation for hematological malignancies and end-stage renal failure. Blood. 2019;134(2):211–5.
O’Donnell PV, Cosimi AB, Sachs D, et al. Combined bone marrow and kidney transplantation for the induction of specific tolerance. Blood. 2016;2016:6471901.
Spitzer TR, Tolkoff-Rubin N, Cosimi AB, et al. Twenty-year follow-up of histocompatibility leukocyte antigen-matched kidney and bone marrow cotransplantation for multiple myeloma with end-stage renal disease: lessons learned. Transplantation. 2019;103(11):2366–72.
Pasquini MC, Hu Z-H, Curran K, et al. Real-world evidence of tisagenlecleucel for pediatric acute lymphoblastic leukemia and non-Hodgkin lymphoma. Blood Adv. 2020;4(21):5414–24.