A multi-center study on safety and efficacy of immune checkpoint inhibitors in cancer patients with kidney transplant.

Autor:	Murakami N; Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: nmurakami1@bwh.harvard.edu., Mulvaney P; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Danesh M; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Abudayyeh A; Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Diab A; Department of Melanoma Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Abdel-Wahab N; Department of Melanoma Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt., Abdelrahim M; Institute for Academic Medicine and Weill Cornell Medical College, Houston Methodist Cancer Center, Houston, Texas, USA., Khairallah P; Division of Nephrology, Columbia University Medical Center, New York, New York, USA., Shirazian S; Division of Nephrology, Columbia University Medical Center, New York, New York, USA., Kukla A; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA., Owoyemi IO; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA., Alhamad T; Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri, USA., Husami S; Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri, USA., Menon M; Division of Nephrology, Recanati Millar Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Santeusanio A; Division of Nephrology, Recanati Millar Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Blosser CD; Divison of Nephrology, University of Washington, Seattle, Washington, USA., Zuniga SC; Divison of Nephrology, University of Washington, Seattle, Washington, USA., Soler MJ; Nephrology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain., Moreso F; Nephrology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain., Mithani Z; Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida, USA., Ortiz-Melo D; Division of Nephrology, Duke University Medical Center, Durham, North Carolina, USA., Jaimes EA; Renal Service, Memorial Sloan Kettering Cancer Center and Weil Cornell Medical College, New York, New York, USA., Gutgarts V; Renal Service, Memorial Sloan Kettering Cancer Center and Weil Cornell Medical College, New York, New York, USA., Lum E; Division of Nephrology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA., Danovitch GM; Division of Nephrology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA., Cardarelli F; Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA., Drews RE; Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA., Bassil C; Division of Nephrology and Hypertension, University of South Florida, Tampa, Florida; Renal Service, H. Lee Moffitt Cancer Center, Tampa, Florida, USA., Swank JL; Division of Nephrology and Hypertension, University of South Florida, Tampa, Florida; Renal Service, H. Lee Moffitt Cancer Center, Tampa, Florida, USA., Westphal S; Division of Nephrology, University of Nebraska Medical Center, Omaha, Nebraska, USA., Mannon RB; Division of Nephrology, University of Nebraska Medical Center, Omaha, Nebraska, USA., Shirai K; Department of Hematology-Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA., Kitchlu A; Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada., Ong S; Division of Nephrology, The University of Alabama at Birmingham, Birmingham, Alabama, USA., Machado SM; Division of Nephrology, The University of Alabama at Birmingham, Birmingham, Alabama, USA., Mothi SS; Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Ott PA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Rahma O; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Hodi FS; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Sise ME; Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA., Gupta S; Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Leaf DE; Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Devoe CE; Division of Medical Oncology and Hematology, Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA., Wanchoo R; Division of Kidney Disease and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA., Nair VV; Division of Kidney Disease and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA., Schmults CD; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Hanna GJ; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Sprangers B; Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Belgium; Department of Nephrology, University Hospitals Leuven, Leuven, Belgium., Riella LV; Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA; Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA., Jhaveri KD; Division of Kidney Disease and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA. Electronic address: Kjhaveri@northwell.edu.
Jazyk:	angličtina
Zdroj:	Kidney international [Kidney Int] 2021 Jul; Vol. 100 (1), pp. 196-205. Date of Electronic Publication: 2020 Dec 24.
DOI:	10.1016/j.kint.2020.12.015
Abstrakt:	Immune checkpoint inhibitors (ICIs) are widely used for various malignancies. However, their safety and efficacy in patients with a kidney transplant have not been defined. To delineate this, we conducted a multicenter retrospective study of 69 patients with a kidney transplant receiving ICIs between January 2010 and May 2020. For safety, we assessed the incidence, timing, and risk factors of acute graft rejection. For efficacy, objective response rate and overall survival were assessed in cutaneous squamous cell carcinoma and melanoma, the most common cancers in our cohort, and compared with stage-matched 23 patients with squamous cell carcinoma and 14 with melanoma with a kidney transplant not receiving ICIs. Following ICI treatment, 29 out of 69 (42%) patients developed acute rejection, 19 of whom lost their allograft, compared with an acute rejection rate of 5.4% in the non-ICI cohort. Median time from ICI initiation to rejection was 24 days. Factors associated with a lower risk of rejection were mTOR inhibitor use (odds ratio 0.26; 95% confidence interval, 0.09-0.72) and triple-agent immunosuppression (0.67, 0.48-0.92). The objective response ratio was 36.4% and 40% in the squamous cell carcinoma and melanoma subgroups, respectively. In the squamous cell carcinoma subgroup, overall survival was significantly longer in patients treated with ICIs (median overall survival 19.8 months vs. 10.6 months), whereas in the melanoma subgroup, overall survival did not differ between groups. Thus, ICIs were associated with a high risk of rejection in patients with kidney transplants but may lead to improved cancer outcomes. Prospective studies are needed to determine optimal immunosuppression strategies to improve patient outcomes. (Copyright © 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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