Charkviani Mariam, Brochero Maria Jose Vargas, Mohan Arjunmohan, Vaughan Lisa E, Sandahl Tyler B, De Menezes Silva Corrae Andre, Lin Yi, Leung Nelson, Herrmann Sandra M
Division of Nephrology and Hypertension, Rochester, MN, USA.
Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Nephrol Dial Transplant. 2025 Jan 13. doi: 10.1093/ndt/gfaf004.
Teclistamab, a novel bispecific monoclonal antibody targeting CD3 and B-cell maturation antigen (BCMA), and chimeric antigen receptor T-cell (CAR-T) therapy are promising options for treating relapsed/refractory multiple myeloma (MM). However, the rates of acute kidney injury (AKI) associated with teclistamab remain inadequately characterized. This study aims to compare the incidence, severity, and outcomes of AKI between patients receiving teclistamab and CAR-T therapy.
This was a retrospective study involving 64 patients with relapsed/refractory MM treated with either teclistamab or CAR-T therapy. All patients had previously received at least four lines of chemotherapy before being treated with either teclistamab or CAR-T. The primary outcome was the incidence of AKI, and secondary outcomes included AKI severity, kidney recovery rates, and mortality. Kaplan-Meier estimates for AKI-free survival were calculated, and hazard ratios (HRs) for AKI risk were determined using Cox proportional hazards models.
Sixty-four patients met inclusion criteria for this study (30 received CAR-T and 34 received teclistamab therapy). Among these patients, 14 AKI events occurred in total (22%), with 10 events (29%) in the teclistamab group and 4 events (13%) in the CAR-T group. AKI-free survival estimates at 180 days after treatment initiation were 68% (95% confidence interval [CI]: 53%-87%) for teclistamab patients and 90% (95% CI: 79%-100%) for CAR-T patients. While patients receiving teclistamab were found to have an increased risk of an AKI event compared to those receiving CAR-T therapy, the results were not statistically significant (HR [95% CI]: 3.38 [0.93-12.31], P = 0.065).
This study suggests that patients treated with teclistamab may experience a higher incidence of AKI compared to those receiving CAR-T therapy. However, further research is required to determine whether this increased risk is attributable to disease progression or teclistamab itself. These results highlight the need for close kidney function monitoring in patients receiving teclistamab.
替雷利珠单抗是一种新型双特异性单克隆抗体，靶向CD3和B细胞成熟抗原（BCMA），嵌合抗原受体T细胞（CAR-T）疗法是治疗复发/难治性多发性骨髓瘤（MM）的有前景的选择。然而，与替雷利珠单抗相关的急性肾损伤（AKI）发生率仍未得到充分描述。本研究旨在比较接受替雷利珠单抗和CAR-T疗法的患者中AKI的发生率、严重程度及预后。
这是一项回顾性研究，纳入64例接受替雷利珠单抗或CAR-T疗法治疗的复发/难治性MM患者。所有患者在接受替雷利珠单抗或CAR-T治疗前均至少接受过四线化疗。主要结局是AKI的发生率，次要结局包括AKI严重程度、肾脏恢复率和死亡率。计算无AKI生存期的Kaplan-Meier估计值，并使用Cox比例风险模型确定AKI风险的风险比（HR）。
64例患者符合本研究的纳入标准（30例接受CAR-T治疗，34例接受替雷利珠单抗治疗）。在这些患者中，共发生14例AKI事件（22%），替雷利珠单抗组10例（29%），CAR-T组4例（13%）。治疗开始后180天，替雷利珠单抗患者的无AKI生存期估计值为68%（95%置信区间[CI]：53%-87%），CAR-T患者为90%（95%CI：79%-100%）。虽然发现接受替雷利珠单抗治疗的患者发生AKI事件的风险高于接受CAR-T疗法的患者，但结果无统计学意义（HR[95%CI]：3.38[0.93-12.31]，P=0.065）。
本研究表明，与接受CAR-T疗法的患者相比，接受替雷利珠单抗治疗的患者AKI发生率可能更高。然而，需要进一步研究以确定这种风险增加是归因于疾病进展还是替雷利珠单抗本身。这些结果凸显了对接受替雷利珠单抗治疗的患者密切监测肾功能的必要性。
