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Participants will receive the study drug injected into an artery within the heart during a procedure in the clinic. They will be followed with visits during the first year, and there is a long term follow up period of 4 years.

The study has a screening period of 8 weeks, a 24 week long treatment period, and a long term extension of 48 weeks where participants can continue to receive the study drug. There are visits approximately 1-2 times a month.

This is a randomized trial, with some participants receiving the study drug and some receiving placebo. The study drug (an oral pill) will be taken daily for 28 days. The total duration of study activities is 9 weeks.

What happens in this study? - People will do a 30-minute interview by phone or Zoom - The interview will be recorded - No follow-up visits or interviews will happen after that

This study includes several steps and lasts about 208 days in total. It begins with a screening period that lasts 28 days. During this time, you will have a full physical exam, your medical history will be reviewed, and you will have routine lab tests, a heart test called an electrocardiogram, and a sensor placed to check your blood sugar levels. If you qualify and choose to join, you will be randomly assigned on the first dose day to receive either the study drug, called CNP-103, or a placebo, which does not contain any active medicine. The medicine or placebo will be given through a vein. The treatment period lasts 90 days, followed by another 90 days of follow-up. During this time, doctors will check how your body reacts to the medicine and how safe it is.

If you join this study, you will be placed into one of two groups by chance. Most people will take a daily pill called tirabrutinib. A smaller group will receive standard treatment with a medicine called rituximab through a vein and another medicine called temozolomide taken by mouth. Treatment happens in cycles that last 28 days. Some people may keep taking the treatment as long as it is helping and safe. During the study, you will have regular doctor visits, scans such as MRI, lab tests, and check ins to watch your health.

Everyone who shows interest and passes an early screening will be invited to join all three design group sessions. At the first session, the team will explain what the sessions are about, the benefits and risks, and ask people to give consent. They will also complete some short assessments. The total time for all three sessions will be about three hours, and the team will schedule them at times that work best for the doctors, patients, and caregivers taking part. All three sessions will be held online. In these sessions, doctors and patient or caregiver participants will help design and improve a new tool that supports medical decision making.

This study does not require much extra time from patients, but doctors will check on them closely for two years. People in the study are placed into groups by chance. Two out of every three people will get the new shoulder device, and one out of three will get the regular device that uses a stem.