Nephrotoxicity in CAR-T Cell Therapy

• Chimeric antigen receptor (CAR)-T cell therapy is generally safe for patients with preexisting renal impairment. • Renal impairment is a significant but typically mild side effect of CAR-T cell therapy. • Post-CAR-T cell infusion monitoring should include blood tests and urine analysis. • Acute kidney injury can worsen clinical outcomes in CAR-T cell-treated patients. Chimeric antigen receptor (CAR)-T cell therapy is a novel therapy for the treatment of different hematologic malignancies. Besides its efficiency, CAR-T cell therapy is associated with significant toxicity, primarily manifested as cytokine release syndrome (CRS) and neurotoxicity. However, there are reports that CAR-T cell therapy is also nephrotoxic and this aspect has attracted less attention to date. In this review, we focus on the incidence and association between CAR-T cell therapy and kidney injury. Here, we describe risk factors, biomarkers, and potential reasons for acute kidney injury (AKI) and chronic kidney disease (CKD) related to CAR-T cell therapy to shed light on pathomechanisms leading to renal impairment as well as to the association of kidney failure with other side effects of CAR-T cell therapy. We also review the toxicity of different types of CAR-T cell products, the impact of nephrotoxicity on CAR-T cell therapy efficacy, and the safety of lymphodepletion in patients with baseline AKI or CKD.