Zanubrutinib Combined With BR in the First-line Treatment of Waldenström's Macroglobulinemia

Inclusion Criteria: 1. Previously untreated symptomatic Waldenström macroglobulinemia (WM) meeting IWWM-7 diagnostic criteria: 1. Presence of monoclonal IgM-type immunoglobulin in serum 2. Bone marrow infiltration by plasmacytoid lymphocytes or bone marrow biopsy showing small lymphocytes/plasma cells/plasmacytoid lymphocytes (any quantity) in the intertrabecular space 3. Exclusion of other non-Hodgkin lymphoma subtypes 4. Typical immunophenotype: CD5-/CD10-/CD19⁺/CD20⁺/CD23-/CD79b⁺ /sIgM⁺/CD138- clonal B-cells. Variant phenotypes may show CD5/CD10/CD23 /CD38 positivity or coexistence of clonal B-cells and plasma cells. 2. MYD88 L265P mutation is detected in peripheral blood or bone marrow. 3. Serum monoclonal IgM ≥5 g/L. Exclusion Criteria: 1. Co-morbidity of uncontrolled infection or autoimmune disease 2. Co-morbidity of other active malignancy 3. Co-morbidity of uncontrolled heart disease 4. Co-morbidity of severe digestive system disorders precluding oral medication 5. Seropositive for human immunodeficiency virus 6. Hepatitis B virus (HBV)-DNA \> 1000 copies/mL 7. Seropositive for hepatitis C (except in the setting of a sustained virologic response) 8. Neutrophil \<1×10E9/L, platelet \< 75×10E9/L, alanine transaminase (ALT) or aspertate aminotransferase (AST) \> 2.5 × upper limit of normal (ULN), total bilirubin \> 1.5 × ULN，eGFR \< 30 mL/min, or receiving renal replacement therapy.