Case Report: Ablation as novel x therapy in the regimen for frail hematological malignancies with extramedullary lesion

Hematological diseases, as a category of malignant tumors originating from the hematopoietic system, have long relied on treatments such as chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. However, challenges remain in managing locally progressive lesions, relapsed/refractory lesions, and involvement of special anatomical sites, especially in infirmities. Ablation technology, as a minimally invasive local treatment method, directly destroys lesion tissues through physical energy and has been widely used in the field of solid tumors. In recent years, with advancements in image-guided technology and the presence of unmet clinical needs in the local treatment of hematological diseases, studies have begun to explore the application of ablation technology in hematological diseases. We retrospectively analyzed 4 frail hematological malignancies cases to discuss the application significance and indications of local ablation therapy in hematological diseases of frail patients, aiming to provide references for clinical practice.Case 1 and Case 2 involved patients with relapsed/refractory multiple myeloma. Both patients had extramedullary lesions in the left maxillary region and the left tibial anterior area, and were unable to tolerate intensive treatment. Case 3 was diagnosed with diffuse large B-cell lymphoma (DLBCL) combined with large extramedullary lesion masses. Case 4 was diagnosed with DLBCL combined with synovial sarcoma. Case 3 and 4 patients were over 80 years old. The four patients were treated with a combination of local ablation and low-dose systemic chemotherapy. After the treatment, all four patients achieved varying degrees of remission, improvement in local compression symptoms, and enhancement of quality of life, with no obvious side effects. Our study demonstrated for the first time the good safety and efficacy of ablation combined with chemotherapy for frail patients, and also indicated that ablation can be used as a new treatment strategy for elderly frail B-cell malignancies patients with local extramedullary lesions who cannot tolerate intense systemic treatment, or for those B-cell malignancies with multiple relapses.