Yamaguchi Shota, Saito Kenki, Shimada Keiji, Kaneko Naoya
Hematology and Oncology, Nara City Hospital, Nara, JPN.
Hematology and Oncology, Nara Prefecture General Medical Center, Nara, JPN.
Cureus. 2025 Jun 29;17(6):e87006. doi: 10.7759/cureus.87006. eCollection 2025 Jun.
Cold agglutinin disease (CAD) is an autoimmune hemolytic anemia characterized by monoclonal immunoglobulin M-mediated cold agglutinins and monoclonal B-cell proliferation. Sutimlimab, a complement C1s inhibitor, alleviates hemolytic anemia in CAD by blocking the classical complement pathway. We report a case of a 67-year-old Japanese woman with CAD who experienced temporal improvement in anemia following sutimlimab treatment. F-fluorodeoxyglucose positron-emission tomography/computed tomography and bone marrow biopsy (BMB) revealed histological transformation into aggressive B-cell lymphoma. Subsequent chemotherapy with polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisolone resulted in further improvement in anemia. This case highlights the importance of reassessing underlying conditions through BMB in cases where sutimlimab treatment is ineffective.
冷凝集素病（CAD）是一种自身免疫性溶血性贫血，其特征为单克隆免疫球蛋白M介导的冷凝集素和单克隆B细胞增殖。苏金单抗是一种补体C1s抑制剂，通过阻断经典补体途径减轻CAD中的溶血性贫血。我们报告一例67岁日本CAD女性患者，接受苏金单抗治疗后贫血出现暂时改善。F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描及骨髓活检（BMB）显示组织学转化为侵袭性B细胞淋巴瘤。随后使用泊洛妥珠单抗、利妥昔单抗、环磷酰胺、多柔比星和泼尼松龙进行化疗，贫血进一步改善。该病例强调了在苏金单抗治疗无效的情况下通过BMB重新评估潜在病情的重要性。
