Orelabrutinib Combined With Rituximab ± Lenalidomide in Response-Adapted Stratified Therapy for Untreated MZL

This trial is testing a treatment combination for a type of slow-growing blood cancer called marginal zone lymphoma (MZL), which includes MALT lymphoma and related subtypes. The combination — orelabrutinib (a targeted oral drug) plus rituximab (an IV antibody), with or without lenalidomide — is being tested in newly diagnosed patients who have not yet received systemic treatment. **You may be eligible if:** - You are 18 years of age or older - You have been diagnosed with marginal zone lymphoma (confirmed by biopsy), including MALT, splenic, or nodal types - Your cancer is at Stage III or IV and requires treatment - You have not previously received systemic therapy (prior local treatments like surgery or radiotherapy are allowed if the cancer later progressed) - You are in reasonably good health (ECOG performance status 0–2) - Your blood counts and organ function are adequate **You may NOT be eligible if:** - You have had another active cancer in the past 5 years - Your lymphoma has spread to the brain or transformed into a more aggressive type - You have significant heart disease (e.g., heart failure Class II or higher) - You are pregnant or breastfeeding Talk to your doctor to see if this trial is right for you.