Strict monitoring of TLS related electrolytes and renal function is required during treatment with Vinaclat, and regular blood routine checks should be conducted to be alert to neutropenia and infection. If there is hematological toxicity or fever of grade 3 or above, the medication should be suspended in a timely manner and corresponding intervention measures should be taken to ensure medication safety.

1、 Tumor Lysis Syndrome (TLS)

1.1 Preventive measures

Before the first administration, tumor burden and renal function should be evaluated. High risk patients should be given allopurinol or febuxostat in advance and adequately hydrated (with daily water intake of ≥ 2L).

1.2 Monitoring Requirements

During the first administration and dose escalation period, blood potassium, blood phosphorus, blood calcium, uric acid, and creatinine should be tested before each new dose.

If nausea, muscle spasms, and decreased urine output occur, seek medical attention immediately.

1.3 Principles of Handling

When diagnosed with TLS, suspend medication, actively correct electrolyte imbalances, and perform hemodialysis if necessary.

2、 Neutropenia

2.1 Monitoring frequency

Before treatment and every 2 weeks, check the blood routine again until it stabilizes, and then once a month thereafter.

2.2 Grading Response

Level 1-2 (ANC ≥ 1.0 × 10 ⁹/L): Continue medication and strengthen monitoring.

Level 3 (ANC0.5~1.0 × 10 ⁹/L): Suspend the use of Vinaccra and restart at the same dose after it returns to ≥ 1.0 × 10 ⁹/L.

Level 4 (ANC<0.5 × 10 ⁹/L): Stop taking the medication until it recovers to ≥ 1.0 × 10 ⁹/L, then reduce to 75% of the original dose and restart.

2.3 Support Measures

G-CSF can be considered to shorten the granulocyte deficiency phase, but it should be used under the guidance of a physician.

3、 Risk of infection

3.1 Risk Identification

Patients with neutropenia lasting for more than 7 days, combined with fever or underlying lung disease, have a significantly increased risk of infection.

3.2 Preventive measures

During treatment, pay attention to hand hygiene, avoid crowds, and regularly perform oral care.

Consider using prophylactic antibiotics (such as fluoroquinolones), especially during periods of neutropenia.

3.3 Infection Management

Once fever (body temperature ≥ 38.3 ℃) or chills occur, Vinaclat should be stopped immediately, and empirical anti infective treatment should be initiated after blood culture collection.

After being diagnosed with infection, it is necessary to adjust the antibacterial regimen based on the pathogen results, and evaluate whether to resume medication after infection control.