eGFR Discordance and Its Association with Outcomes After Allogeneic Hematopoietic Stem Cell Transplantation and Adoptive T-Cell Therapies.

KEY POINTS: eGFR discordance was associated with higher risk of AKI in allogeneic hematopoietic stem cell transplantation and adoptive T-cell therapies. Among hematopoietic stem cell transplantation recipients, eGFR discordance was associated with slower time-to-platelet engraftment. Among adoptive T-cell recipients, eGFR discordance was associated with prolonged cytopenia.

BACKGROUND

Discordance between eGFR on the basis of serum creatinine (eGFR cr ) versus cystatin C (eGFR cys ) is associated with adverse outcomes in patients with and without cancer. We hypothesized that eGFR discordance is associated with AKI and death after hematopoietic stem cell transplantation (HSCT) or receipt of adoptive T-cell therapies.

METHODS

We conducted a multicenter study of adults receiving allogeneic HSCT and adoptive T-cell therapies who had paired serum creatinine and cystatin C values obtained in the 30 days preceding conditioning or lymphodepleting chemotherapy. The primary exposure was eGFR discordance, defined as eGFR cys ≥30% lower than eGFR cr . The primary outcome was a composite outcome of AKI (≥50% increase in serum creatinine or receipt of KRT) or death within 90 days after HSCT or adoptive T-cell infusion. Secondary outcomes included time-to-platelet engraftment in HSCT and prolonged cytopenia in adoptive T-cell recipients. We used multivariable logistic regression and cause-specific Cox regression with inverse probability weighting to adjust for confounders.

RESULTS

Of 274 patients receiving HSCT (median age, 65 years; interquartile range, 52-71; 43% female), 86 (31%) had an eGFR discordance. Among 236 adoptive T-cell recipients (median age, 67 years; interquartile range, 60-74; 59% female), 78 (33%) had a discordance in eGFR. eGFR discordance was associated with higher odds of AKI or death in HSCT (odds ratio, 1.75; 95% confidence interval, 1.03 to 3.02) and adoptive T-cell recipients (odds ratio, 2.37; 95% confidence interval, 1.12 to 4.94). However, adjustment for eGFR cr-cys attenuated these associations in both cohorts. eGFR discordance was also associated with slower time-to-platelet engraftment in HSCT recipients and prolonged cytopenia after adoptive T-cell therapy.

CONCLUSIONS

A pretreatment eGFR discordance was associated with AKI or death in HSCT and adoptive T-cell recipients; however, this association was attenuated after adjusting for eGFR cr-cys .