CAR-T Cells and the Kidney: Insights from the WHO Safety Database

Background Chimeric antigen receptor T (CAR-T) cells have proven to be a game changer for treating several hematologic malignancies. Randomized controlled trials have highlighted potential life-threatening adverse drug reactions (ADRs), including cytokine release syndrome (CRS). Acute renal failure (ARF) has also been reported in 20% of the patients treated. However, an analysis of renal safety supported by large-scale real-life data seems warranted. Patients and methods We queried VigiBase® for all reports of the Standardised MedDRA Query “acute renal failure” (ARF) involving a CAR-T cell, registered until 24 July 2022. Disproportionality for this ADR was analyzed through calculation of the Information Component [IC (95% confidence interval)]. A positive lower end of the 95% confidence interval of the IC is the threshold used in statistical signal detection in VigiBase®. The same analysis was carried out for various hydroelectrolytic disorders. Results We gathered 224 reports of ARF, and 125 reports of hydroelectrolytic disorders involving CAR-T cells. CAR-T cells were disproportionately reported with ARF [IC 1.5 (1.3–1.7)], even after excluding reports mentioning CRS. A significant disproportionate reporting was also found for hypernatremia [IC 3.1 (2.2–3.8)], hyperphosphatemia [IC 3.1 (1.8–3.9)], hypophosphatemia [IC 2.0 (0.6–2.9)], metabolic acidosis [IC 1.8 (1.2–2.2)], hyponatremia [IC 1.6 (1.1–2.0)], and hypercalcemia [IC 1.4 (0.5–2.1)]. There was no disproportionate reporting of dyskalemia. Conclusions This study is limited by the inherent flaws of pharmacovigilance approaches. Nonetheless, our findings suggest that ARF and an array of hydroelectrolytic disorders are potential ADRs of CAR-T cell therapy, in real-life settings and in a nonselected population.