Phase II Trial of Zanubrutinib, Obinutuzumab, Bendamustine (ZGB) as First-Line Therapy for Chronic Lymphocytic Leukemia: A Single-Center Study

Prior treatment

• Recent Surgery: Major surgery within 30 days.

Other illness

• Malignancy: History of active malignancy (excluding CLL) within the past year, including CNS lymphoma.
• Disease Transformation: Richter transformation or prolymphocytic leukemia (PLL).
• Autoimmune Cytopenias: Active autoimmune hemolysis or thrombocytopenia requiring corticosteroids.
• Comorbidities: Uncontrolled diabetes, cardiac/pulmonary disease, or conditions deemed by investigators to affect study safety.
• Infections: Active systemic infection requiring IV antibiotics.
• Bleeding Risks: History of life-threatening hemorrhage or need for high-dose anticoagulation.
• Drug Tolerance: Hypersensitivity to any study drug components.
• Viral Infections: Active HBV (HBsAg+ or HBV-DNA+) or HCV.
• Other: Investigator-determined ineligibility (e.g., poor compliance, psychiatric disorders).

Lab values

• Organ Dysfunction: ALT/AST \>3×ULN; total bilirubin \>2×ULN; creatinine \>1.5×ULN.

Other

• Reproductive Status: Pregnancy, lactation, or unwillingness to use contraception.

• Demographics: Age ≥18 years, regardless of gender.
• Diagnosis: Confirmed diagnosis of untreated chronic lymphocytic leukemia (CLL) per iwCLL 2018 criteria.
• Treatment Naivety:
  • No prior systemic therapy for CLL, including:
  • CHOP/COP-based chemotherapy.
  • Regimens containing fludarabine or bendamustine.
  • Anti-CD20 monoclonal antibodies (e.g., rituximab) or BTK inhibitors (e.g., ibrutinib).
  • Chlorambucil or cyclophosphamide (\>3 weeks of use).
  • Interferon therapy (\>6 months of use).
• Treatment Indications:
  • Must meet ≥1 of the following (iwCLL 2018 criteria):
  • Hemoglobin \<100 g/L (non-hemolytic).
  • Platelets \<100×10⁹/L with progressive decline.
  • Lymphadenopathy (longest diameter \>10 cm) or massive splenomegaly (\>6 cm below costal margin).
  • Constitutional symptoms: unexplained fever (\>38°C ×2 weeks), night sweats, or \>10% weight loss in 6 months.
  • Rapid disease progression (lymphocyte doubling time \<6 months, 50% lymph node growth in 2 months, or rapid cytopenia).
• Performance Status: ECOG performance status ≤2.
• Organ Function (within 7 days before enrollment):
  • Hematologic:
  • ANC ≥1.0×10⁹/L (without growth factor support).
  • Platelets ≥50×10⁹/L (without transfusion).
  • Hepatic: AST/ALT ≤2.5×ULN; total bilirubin ≤1.5×ULN.
  • Renal: Estimated CrCl ≥30 mL/min (Cockcroft-Gault formula).
• Consent: Signed informed consent.