Safety of CAR T-cell therapy in kidney transplant recipients

Recipients of solid organ transplant are at increased risk to develop posttransplant lymphoproliferative disorder (PTLD). However, only 30% to 40% achieve a durable response. 2,3 Chimeric antigen receptor (CAR) T-cell therapy is a novel treatment with a substantial response (52% to 82%) in patients with relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL), 4,5 but its safety and efficacy in PTLD is unknown. Two CAR T-cell therapy products, axi-cel and tisagenlecleucel, are currently approved for r/r DLBCL and both are derived from autologous T cells. Because solid organ transplant recipients are on long-term immunosuppressive therapy to prevent allograft rejection, there is concern about the feasibility of generating an effective autologous CAR T-cell product. Here, we report the safety and efficacy of autologous CAR T-cell therapy in 3 patients with r/r DLBCL and kidney allograft who were treated with axi-cel in 2019 to 2020.