Acalabrutinib, as a BTK inhibitor, should be used with a focus on bleeding risk, infection prevention and control, and medication safety for special populations. The following six core precautions will be explained in detail.

1. Risk control of bleeding

(1) Serious bleeding events may occur, including intracranial hemorrhage and gastrointestinal bleeding, especially when combined with anticoagulant/antiplatelet drugs, which pose a higher risk

(2) Medication should be suspended 3-7 days before surgery, and treatment can only be resumed after the wound heals after surgery

(3) Immediate medical evaluation should be sought when unexplained bruising, hematuria, or black stool appears

2 Infection prevention and control measures

(1) The risk of opportunistic infections has significantly increased, including PJP pneumonia and CMV reactivation

(2) It is recommended to screen for HBV, HCV, and HIV infection status before treatment

(3) Immediate microbiological examination is required for persistent fever or respiratory symptoms

3. Cardiac Event Monitoring

(1) May induce atrial fibrillation/flutter, patients with underlying heart disease require electrocardiographic monitoring

(2) Increased risk of arrhythmia when combined with CYP3A4 inhibitors

(3) Emergency electrocardiogram examination is required for symptoms such as palpitations and fainting

4 Hematological toxicity

(1) Monthly monitoring of whole blood cell count during treatment

(2) Grade 3 or above neutropenia requires consideration of G-CSF support

(3) When the platelet count is less than 50 × 10 ⁹/L, medication should be suspended

Medication for 5 special populations

(1) Women of childbearing age need to use dual contraception for 7 days after the last dose

(2) Patients with moderate to severe liver damage need to reduce their dosage by 50%

(3) Prohibited during lactation, elderly patients do not need to adjust dosage

6 Drug Interactions

(1) Strong CYP3A inhibitors/inducers require dosage adjustment

(2) Avoid long-term use with proton pump inhibitors

(3) Warfarin and other anticoagulants require close monitoring of INR values