Clinical outcomes following CAR T-cell therapy in relapsed or refractory multiple myeloma patients with baseline renal dysfunction: A TriNetX analysis.

Abstract

7539 Background: Renal dysfunction is common in relapsed or refractory multiple myeloma (RRMM) and has historically limited eligibility for chimeric antigen receptor T-cell (CAR-T) therapy. However, real world data evaluating early complications and long-term outcomes in this population remains limited. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including adult RRMM patients treated with idecabtagene vicleucel or ciltacabtagene autoleucel. Patients with baseline renal dysfunction (creatinine ≥ 2.0 mg/dl, not on dialysis) were compared with those with preserved renal function (creatinine ≤ 1.0 mg/dl) after propensity matching. Early post-CAR-T complications: cytokine release syndrome (CRS) and disseminated intravascular coagulation (DIC) were assessed from day 0 to 15 post CAR-T therapy. Mortality was evaluated at 6 months, 1 year and 3 years. A secondary exploratory analysis assessed renal recovery at 90 days in patients with renal dysfunction following CART-cell infusion using creatinine based (≤ 1.9 mg/dl) and eGFR based (≥50 mL/min/1.73 m²) definitions. Results: 84/777 (10.8%) RRMM patients who received CAR T-cell therapy had baseline renal dysfunction. After propensity matching, 79 patients were included in each cohort, demographics in Table 1. 0-15 day CRS incidence was similar in patients with and without renal dysfunction (36.5% vs 33.3%), and no patients developed DIC or required dialysis at any point of time. Mortality was significantly higher in patients with renal dysfunction at 6 months (40% vs 13.2%), 1 year (45.3% vs 15.8%), and 3 years (52% vs 21.1%). Among patients with baseline renal dysfunction and available 90 day follow-up (61/79); renal recovery occurred in 48/61 (78.7%) by creatinine and in 38/61 (62.3%) by eGFR criteria. Conclusions: Baseline renal dysfunction was not associated with increased CRS incidence or progression of renal disease needing dialysis but was associated with higher long-term mortality, likely reflecting greater myeloma burden. Most patients with baseline renal dysfunction demonstrated renal recovery within 90 days, though they remain underrepresented among CAR-T recipients, highlighting a potential treatment gap. Baseline characteristics of both cohorts. Demographic parameter Baseline renal dysfunction cohort, N=79(n, %) Preserved renal dysfunction cohort, N=79, (n, %) Race White 54 (68.4%) 58 (73.4%) Black or African American 14 (17.7%) 15 (19%) Sex Female 26 (32.9%) 26 (32.9%) Male 53 (67.1%) 53 (67.1%) Lab Parameters Baseline renal dysfunction cohort, Mean ± SD Preserved renal dysfunction cohort, Mean ± SD Hemoglobin 9.5 ± 1.7 10.3 ± 2.2 Hematocrit 28.4 ± 5.0 31.0 ± 6.4 Urea Nitrogen 27.2 ± 13.1 14.6 ± 5.5 Bicarbonate 21.8 ± 3.7 24.6 ± 3.1 Ferritin 1587.7 ± 3073.6 628.8 ± 1099.9