How is Cold Agglutinin Disease (CAD) Treated?
- How cold agglutinin disease (CAD) is treated will depend on if the disease was brought on by an underlying condition.
- The disease can be caused by an infection such as pneumonia, an immune condition like lupus, or certain blood cancers such as lymphoma.
- For some patients, avoiding the cold may be the only treatment that’s needed.
- For others, monoclonal antibodies may be used to inhibit the destruction of red blood cells.
Cold agglutinin disease (CAD) is a rare, autoimmune disorder where a person’s body is attacked by its own immune system. The disease can be triggered, with worsening symptoms, by the cold. CAD can occur on its own, but the disease can also be caused by several things, including infections such as pneumonia, immune conditions like lupus, or blood cancers such as lymphoma or chronic lymphocytic leukemia (CLL).
The approach to treating CAD will depend on if there is some underlying condition that caused the disease. For example, if CAD was caused by an infection, your doctor will want to treat the infection and the CAD will likely go away as well when the infection clears up. It gets a bit more complicated when doctors are unsure what caused the CAD.
Determining When to Treat CAD
Not everyone who is diagnosed with CAD will require treatment. In fact, some people may be able to simply make a few lifestyle adjustments.
“The first step is to determine whether they actually need to be treated or not,” Dr. Roy Smith, a hematologist/oncologist at the University of Pittsburgh, tells SurvivorNet. “Often, it’s a matter of just telling a person to wear gloves or wear a coat, keep their house at a higher temperature, or move to another place … something along those lines.”
Dr. Smith explains that in patients who are otherwise in good health and not experiencing many symptoms from CAD, which could be things like anemia and fatigue, treatment may just require avoiding the cold.
Treatment Options
If the rate of red blood cells being destroyed seems to be increasing, treatment may be required. Rituximab, which is a drug called a monoclonal antibody, is considered a “first-line” therapy for CAD, meaning it can be given as a first attempt at treatment. It may be combined with a chemotherapy agent or with the steroid, prednisone.
“A fair number of people respond [to rituximab],” Dr. Smith explains. “It’s a pretty simply therapy to give, although you have to give it multiple times.” Rituximab is given intravenously.
The Food and Drug Administration (FDA) also recently approved a drug called Enjaymo, or sutimlimab-jome, to treat CAD. Sutimlimab-jome is also a monoclonal antibody. The drug works by inhibiting the destruction of red blood cells (hemolysis).
“So, you can give people this monoclonal antibody … you can give that for four or five days and then repeat it as needed, usually every three or four weeks, depending on how people respond to it, and you’d see some very dramatic responses over a relatively short period of time,” Dr. Smith explains, noting that the drug has shown a lot of promise.
When CAD is caused by an underlying condition
When CAD is caused by something like cancer or an infection, the treatment plan will involve taking care of that underlying condition.
“As an example, if a person had cold agglutinin disease associated with lymphoma, you would treat the lymphoma and the cold agglutinin disease generally goes away,” Dr. Smith explains. “You can also get cold agglutinin disease from various infections. Probably the most common infection would be just infectious mononucleosis. You can get cold agglutinin disease from that. It’s generally self-limited because the disease itself is self-limited.”
Self-limited in this situation means that the disease will go away once the underlying cause is resolved. Dr. Jun Choi, a hematologist/oncologist at NYU Langone’s Perlmutter Cancer Center, tells SurvivorNet that when doctors can identify an infection as the cause of CAD—more commonly seen in younger patients—treatment often yields good results.
“CAD can also be caused by particular types of infections, such as mycoplasma, pneumonia, or other types of viruses … and this is more common in young patients,” he says. “When it is caused by those infections, you want to really treat those infections with antibiotics and antivirus medication. Usually the CAD goes away when the infections are treated.”
When the disease is caused by some type of autoimmune disorder, like rheumatoid arthritis or lupus, treating the root cause also tends to be effective, resulting in the CAD going away, Dr. Choi says.
Learn more about SurvivorNet's rigorous medical review process.
How is Cold Agglutinin Disease (CAD) Treated?
- How cold agglutinin disease (CAD) is treated will depend on if the disease was brought on by an underlying condition.
- The disease can be caused by an infection such as pneumonia, an immune condition like lupus, or certain blood cancers such as lymphoma.
- For some patients, avoiding the cold may be the only treatment that’s needed.
- For others, monoclonal antibodies may be used to inhibit the destruction of red blood cells.
Cold agglutinin disease (CAD) is a rare, autoimmune disorder where a person’s body is attacked by its own immune system. The disease can be triggered, with worsening symptoms, by the cold. CAD can occur on its own, but the disease can also be caused by several things, including infections such as pneumonia, immune conditions like lupus, or blood cancers such as lymphoma or chronic lymphocytic leukemia (CLL).
The approach to treating CAD will depend on if there is some underlying condition that caused the disease. For example, if CAD was caused by an infection, your doctor will want to treat the infection and the CAD will likely go away as well when the infection clears up. It gets a bit more complicated when doctors are unsure what caused the CAD.
Determining When to Treat CAD
Read More Not everyone who is diagnosed with CAD will require treatment. In fact, some people may be able to simply make a few lifestyle adjustments.
“The first step is to determine whether they actually need to be treated or not,” Dr. Roy Smith, a hematologist/oncologist at the University of Pittsburgh, tells SurvivorNet. “Often, it’s a matter of just telling a person to wear gloves or wear a coat, keep their house at a higher temperature, or move to another place … something along those lines.”
Dr. Smith explains that in patients who are otherwise in good health and not experiencing many symptoms from CAD, which could be things like anemia and fatigue, treatment may just require avoiding the cold.
Treatment Options
If the rate of red blood cells being destroyed seems to be increasing, treatment may be required. Rituximab, which is a drug called a monoclonal antibody, is considered a “first-line” therapy for CAD, meaning it can be given as a first attempt at treatment. It may be combined with a chemotherapy agent or with the steroid, prednisone.
“A fair number of people respond [to rituximab],” Dr. Smith explains. “It’s a pretty simply therapy to give, although you have to give it multiple times.” Rituximab is given intravenously.
The Food and Drug Administration (FDA) also recently approved a drug called Enjaymo, or sutimlimab-jome, to treat CAD. Sutimlimab-jome is also a monoclonal antibody. The drug works by inhibiting the destruction of red blood cells (hemolysis).
“So, you can give people this monoclonal antibody … you can give that for four or five days and then repeat it as needed, usually every three or four weeks, depending on how people respond to it, and you’d see some very dramatic responses over a relatively short period of time,” Dr. Smith explains, noting that the drug has shown a lot of promise.
When CAD is caused by an underlying condition
When CAD is caused by something like cancer or an infection, the treatment plan will involve taking care of that underlying condition.
“As an example, if a person had cold agglutinin disease associated with lymphoma, you would treat the lymphoma and the cold agglutinin disease generally goes away,” Dr. Smith explains. “You can also get cold agglutinin disease from various infections. Probably the most common infection would be just infectious mononucleosis. You can get cold agglutinin disease from that. It’s generally self-limited because the disease itself is self-limited.”
Self-limited in this situation means that the disease will go away once the underlying cause is resolved. Dr. Jun Choi, a hematologist/oncologist at NYU Langone’s Perlmutter Cancer Center, tells SurvivorNet that when doctors can identify an infection as the cause of CAD—more commonly seen in younger patients—treatment often yields good results.
“CAD can also be caused by particular types of infections, such as mycoplasma, pneumonia, or other types of viruses … and this is more common in young patients,” he says. “When it is caused by those infections, you want to really treat those infections with antibiotics and antivirus medication. Usually the CAD goes away when the infections are treated.”
When the disease is caused by some type of autoimmune disorder, like rheumatoid arthritis or lupus, treating the root cause also tends to be effective, resulting in the CAD going away, Dr. Choi says.
Learn more about SurvivorNet's rigorous medical review process.
