Zanubrutinib, Obinutuzumab, and Lenalidomide (ZGR) in the Treatment of Newly Diagnosed Splenic B-cell Lymphoma With Prominent Nucleoli (SBLPN): A Prospective, Open-label, Single-arm Clinical Trial

Inclusion Criteria: * Aged 18 to 80 years, male or female * Histologically or cytologically confirmed SBLPN requiring active treatment; * No prior systemic therapy for SBLPN received; * ECOG performance status of 0-2; * Anticipated life expectancy ≥6 months; * Laboratory parameters (hematologic and biochemical) meeting the following criteria: * a. Absolute neutrophil count (ANC) ≥1.0 × 10⁹/L, platelet count ≥50 × 10⁹/L; * b. Total bilirubin (TBIL) ≤2.0 × upper limit of normal (ULN); * c. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 × ULN; * d. Creatinine clearance ≥50 mL/min (calculated via Cockcroft-Gault formula or direct measurement). * Men and women of childbearing potential must agree to use medically approved contraception throughout the study and for 4 weeks after treatment discontinuation; * Participants must voluntarily enroll in the study and provide written informed consent. Exclusion Criteria: * History of central nervous system (CNS) disorders (including CNS lymphoma) diagnosed within 1 year prior to enrollment. * Other primary malignancies within the past 3 years (excluding non-melanoma skin cancer, curatively treated localized prostate cancer, cervical carcinoma in situ, or squamous intraepithelial lesions on PAP smear). * Exposure to any investigational drugs, antimicrobial agents, or participation in other interventional clinical trials within 4 weeks prior to enrollment. * Major surgery (excluding lymph node biopsy) within 14 days before enrollment or anticipated requirement for major surgery during the study. * Prior use of investigational agents targeting SBLPN. * Active immunodeficiency, autoimmune diseases, prolonged systemic corticosteroid therapy (\>10 mg/day prednisone equivalent) within 7 days prior to enrollment, or any immunosuppressive therapy. * Severe hepatic dysfunction (e.g., severe jaundice, hepatic encephalopathy, refractory ascites, hepatorenal syndrome), cachexia, multiorgan failure, or severe renal impairment. * Clinically significant cardiovascular comorbidities: New York Heart Association (NYHA) class III/IV heart failure; Myocardial infarction within 6 months prior to enrollment; Uncontrolled arrhythmias (including QTc interval ≥480 ms); Poorly controlled hypertension (systolic ≥150 mmHg/diastolic ≥100 mmHg despite antihypertensives); Unstable angina. * Bleeding diathesis or coagulation disorders; thrombotic events within 3 months prior to enrollment. * Hypersensitivity to active ingredients or excipients of the investigational drugs. * Pregnancy, lactation, or women of childbearing potential unwilling/unable to use contraception. * Other conditions deemed unsuitable for participation by the investigator (e.g., compromised protocol compliance or safety risks).