bortezomib + rituximab + ibrutinib

A combination regimen of three active pharmaceutical agents: **bortezomib**, **rituximab**, and **ibrutinib**. - **Bortezomib** is a small molecule proteasome inhibitor that disrupts protein degradation leading to cell cycle arrest and apoptosis in malignant cells. - **Rituximab** is a monoclonal antibody that targets the CD20 antigen present on the surface of B-lymphocytes, resulting in cell lysis by direct and immune-mediated mechanisms. - **Ibrutinib** is a small molecule oral Bruton's tyrosine kinase (BTK) inhibitor, blocking B-cell receptor signaling and interrupting downstream proliferation and survival pathways in B-cell malignancies. This triple combination has been investigated in the first-line treatment of Waldenström’s macroglobulinemia (WM), with clinical evidence indicating high efficacy and a manageable safety profile. Each drug targets a different component of tumor cell survival and signaling, leading to a combinatorial effect for treating B-cell malignancies, especially WM and other related hematologic diseases[5][4][6].