Chimeric antigen receptor T-cell therapy in a dialysis patient with lymphoma

Abstract

Chimeric antigen receptor T-cell (CAR-T) therapy has become a revolutionary cancer therapy for multiple subtypes of hematologic malignancies. Despite this progress, 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 who had developed diffuse large B-cell lymphoma (DLBCL) from an underlying chronic lymphocytic leukemia. The patient received CAR-T therapy, preceded by lymphodepleting chemotherapy with dose-reduced fludarabine and cyclophosphamide, followed by intermittent hemodialysis on a modified basis. The treatment course was complicated by pancytopenia and Grade 2 cytokine release syndrome, managed with tocilizumab. The patient underwent an initial disease response assessment, which showed a complete response, and remains in remission 12 months after CAR-T infusion. This case report highlights the importance of individualized hemodialysis schedules and lymphodepleting chemotherapy dose adjustments in ESKD patients for a successful administration of CAR-T therapy.