Would you use sutimlimab for cold agglutinin disease/syndrome in patients with a concurrent hematologic malignancy?

The CARDINAL trial excluded patients with active malignancy, and thus in general I would not use sutimlimab in patients with CAD in context of a concurrent hematologic malignancy. Additionally, one would hope that treating the hematologic malignancy would address CAD mediated hemolysis, without requiring sutimlimab.

An exception to this is severe hemolysis requiring recurrent transfusions, where the time to response of cancer related therapy may not be fast enough to address hemolysis. We know from CADENZA and CARDINAL trials, as well as clinical practice, that hemolysis is mitigated within days of administration of first sutimlimab dose.