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Lymphoma zanubrutinib

Patients with lymphoma should be considered for inclusion into clinical trials. Link to ALLG website, ANZCTR website and Lymphoma Australia website.

Some indications in this protocol are based on limited evidence; please refer to the individual evidence sections for more information.

This protocol does not have a calculator.

The anticancer drug(s) in this protocol may have been included in the ADDIKD guideline. Dose recommendations in kidney dysfunction have yet to be updated to align with the ADDIKD guideline. Recommendations will be updated once the individual protocol has been evaluated by the reference committee. For further information refer to the ADDIKD guideline. To assist with calculations, use the eviQ Estimated Glomerular Filtration Rate (eGFR) calculator.

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The supportive therapies (e.g. antiemetics, premedications, etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Continuous treatment
Zanubrutinib 160 mg (PO) TWICE a day , approximately 12 hours apart.* Can be taken with or without food. Swallow capsules whole with a glass of water.

*Can be given as 320 mg ONCE daily, at the discretion of the treating clinician.

Continuous until disease progression or unacceptable toxicity

The supportive therapies (e.g. antiemetics, premedications, etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Continuous treatment
Zanubrutinib 160 mg (PO) TWICE a day , approximately 12 hours apart.* Can be taken with or without food. Swallow capsules whole with a glass of water.

*Can be given as 320 mg ONCE daily, at the discretion of the treating clinician.

Continuous until disease progression or unacceptable toxicity

  • Mantle cell lymphoma in patients who have received at least one prior therapy.
  • Waldenstrom macroglobulinaemia following at least one prior therapy.
  • Previously untreated Waldenstrom macroglobulinaemia in patients unsuitable for chemoimmunotherapy.
Caution with oral anti-cancer drugs

Select links for information on the safe prescribing, dispensing and administration of orally administered anti-cancer drugs. 

Read more about the COSA guidelines and oral anti-cancer therapy
Emetogenicity LOW

Antiemetics are not routinely required; however should a patient experience emesis:

Metoclopramide 10 mg three times a day when necessary (maximum of 30 mg/24 hours, up to 5 days) OR

Prochlorperazine 10 mg PO every 6 hours when necessary may be administered.

Read more about preventing anti-cancer therapy induced nausea and vomiting
Cardiac toxicity

Zanubrutinib has been associated with atrial fibrillation and flutter, particularly in patients with cardiac risk factors, hypertension and acute infections. Patients should be monitored for signs and symptoms of atrial fibrillation and atrial flutter and managed as appropriate.

Patients who develop arrhythmic symptoms or new onset of dyspnoea should be evaluated clinically, and if indicated, an electrocardiogram (ECG) should be performed.

Read more about cardiac toxicity associated with anti-cancer drugs
Haemorrhage

Haemorrhagic events have been reported, both with and without thrombocytopenia. These include minor haemorrhagic events (i.e. contusion, epistaxis, petechiae) and major haemorrhagic events (i.e. gastrointestinal bleeding, intracranial haemorrhage, haematuria).

Zanubrutinib may increase the risk of haemorrhage in patients receiving antiplatelet or anticoagulant therapies. Patients should be monitored for signs of bleeding. 

Consider the benefit-risk of withholding zanubrutinib at least 3 to 7 days pre and post-surgery depending on the risk of bleeding and type of surgery.
Infection risk

Fatal and non-fatal infections (including bacterial, viral or fungal) have occurred in patients treated with zanubrutinib monotherapy. The most common grade 3 or higher infection was pneumonia. Infections due to hepatitis B virus (HBV) or herpes zoster virus reactivation have also occurred.

Consider prophylaxis according to standard of care in patients who are at increased risk for infections. Monitor for signs and symptoms of infection and treat appropriately. 
Pneumocystis jirovecii pneumonia (PJP) prophylaxis

PJP prophylaxis is recommended e.g. trimethoprim/sulfamethoxazole 160/800 mg PO one tablet twice daily, twice weekly (e.g. on Mondays and Thursdays) OR one tablet three times weekly (e.g. on Mondays, Wednesdays and Fridays).

Read more about prophylaxis of pneumocystis jiroveci (carinii) in cancer patients
Antiviral prophylaxis

Antiviral prophylaxis is recommended.

Read more about antiviral prophylaxis drugs and doses
Antifungal prophylaxis

Consider antifungal prophylaxis for at-risk patients. 

Clinical vigilance and early intervention is recommended in patients with an increased risk of fungal infections.

Read more about antifungal prophylaxis drugs and doses.
Blood tests

FBC, EUC and LFTs at baseline and repeat monthly during treatment or as clinically indicated.
Hepatitis B screening and prophylaxis

Routine screening for HBsAg and anti-HBc is recommended prior to initiation of treatment. Prophylaxis should be determined according to individual institutional policy.

Read more about hepatitis B screening and prophylaxis in cancer patients requiring cytotoxic and/or immunosuppressive therapy
Vaccinations

Live vaccines are contraindicated in cancer patients receiving immunosuppressive therapy and/or who have poorly controlled malignant disease.

Refer to the recommended schedule of vaccination for immunocompromised patients, as outlined in the Australian Immunisation Handbook.

Read more about COVID-19 vaccines and cancer.
Fertility, pregnancy and lactation

Cancer treatment can have harmful effects on fertility and this should be discussed with all patients of reproductive potential prior to commencing treatment. There is a risk of foetal harm in pregnant women. A pregnancy test should be considered prior to initiating treatment in females of reproductive potential if sexually active. It is important that all patients of reproductive potential use effective contraception whilst on therapy and after treatment finishes. Effective contraception methods and adequate contraception timeframe should be discussed with all patients of reproductive potential. Possibility of infant risk should be discussed with breastfeeding patients.

Read more about the effect of cancer treatment on fertility
Evidence for dose modifications is limited, and the recommendations made on eviQ are intended as a guide only. They are generally conservative with an emphasis on safety. Any dose modification should be based on clinical judgement, and the individual patient’s situation including but not limited to treatment intent (curative vs palliative), the anti-cancer regimen (single versus combination therapy versus chemotherapy versus immunotherapy), biology of the cancer (site, size, mutations, metastases), other treatment related side effects, additional co-morbidities, performance status and patient preferences.Suggested dose modifications are based on clinical trial findings, product information, published guidelines and reference committee consensus . The dose reduction applies to each individual dose and not to the total number of days or duration of treatment cycle unless stated otherwise. Non-haematological gradings are based on Common Terminology Criteria for Adverse Events (CTCAE) unless otherwise specified. Renal and hepatic dose modifications have been standardised where possible. For more information see dosing considerations & disclaimer.
The dose recommendations in kidney dysfunction (i.e.renal impairment) displayed may not reflect those in the ADDIKD guideline and have been included for historical reference only. Recommendations will be updated once the individual protocol has been evaluated by the reference committee, with this version of the protocol then being archived. Clinicians are expected to refer to the ADDIKD guideline prior to prescribing in kidney dysfunction.
International Consensus Guideline for Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD).
Haematological toxicity
ANC x 109/L

Less than 1.0 with infection or fever

OR

Less than 0.5 lasting longer than 10 consecutive days

Delay treatment until recovery and recommence zanubrutinib as below:
1st occurrence: No dose reduction
2nd occurrence: Reduce zanubrutinib to 160 mg ONCE daily or 80 mg TWICE daily*
3rd occurrence: Reduce zanubrutinib to 80 mg ONCE daily
4th occurrence: Cease treatment
* Consider the use of daily G-CSF prophylaxis, which can be reduced in frequency as response allows, in preference to dose reductions.r
Platelets x 109/L

25 to 50 with bleeding

OR

Less than 25 lasting longer than 10 consecutive days

 Delay treatment until recovery and recommence zanubrutinib as below:
1st occurrence: No dose reduction
2nd occurrence: Reduce zanubrutinib to 160 mg ONCE daily or 80 mg TWICE daily
3rd occurrence: Reduce zanubrutinib to 80 mg ONCE daily
4th occurrence: Cease treatment
Renal impairment
Creatinine clearance (mL/min)
Greater than 30 No dose adjustments necessary
Less than 30 Monitor for adverse reactions
Hepatic impairment
Hepatic dysfunction
Dose modifications are not needed in patients with mild or moderate hepatic impairment.
Severe (Child-Pugh class C)

Recommended dose is 80 mg TWICE daily

Note: The safety of zanubrutinib has not been evaluated in patients with severe hepatic impairment. Monitor patients closely for adverse reactions
Non-Haematological toxicity
Greater than or equal to grade 3 Delay treatment until recovery and recommence zanubrutinib as below:
1st occurrence: No dose reduction
2nd occurrence: Reduce zanubrutinib to 160 mg ONCE daily or 80 mg TWICE daily
3rd occurrence: Reduce zanubrutinib to 80 mg ONCE daily
4th occurrence: Cease treatment
Intracranial haemorrhage (any grade) Discontinue zanubrutinib
Concomitant use with CYP3A4 inhibitor
Moderate CYP3A4 inhibitor

Reduce zanubrutinib dose to 80 mg TWICE daily for the duration of inhibitor use

Modify dose for adverse events
Strong CYP3A4 inhibitor 

Reduce zanubrutinib dose to 80 mg ONCE daily for the duration of inhibitor use

Interrupt dose for adverse events

Note: After discontinuation of a CYP3A4 inhibitor, resume previous dose of zanubrutinib.

Drug interactions in eviQ protocols are under review and being updated to align with current literature. Further site-wide updates and changes will occur in due course. References & Disclaimer

The drug interactions shown below are not an exhaustive list. For a more comprehensive list and for detailed information on specific drug interactions and clinical management, please refer to the specific drug product information and the following key resources:  

Zanubrutinib
  Interaction Clinical management

Strong CYP3A4 inhibitors (e.g. posaconazole, voriconazole,  clarithromycin, ritonavir etc.)

Moderate CYP3A4 inhibitors (e.g. ciprofloxacin, diltiazem, erythromycin, fluconazole, verapamil, grapefruit juice, Seville oranges etc.​)

 Potentially increased zanubrutinib toxicity due to increased plasma concentrations.

Reduce dose to 80 mg once daily if  co-administered with a strong CYP3A4 inhibitor.

Reduce dose to 80 mg twice daily if  co-administered with a moderate CYP3A4 inhibitor.

Monitor patients closely for zanubrutinib toxicities; further dose adjustments may be required.

If CYP3A4 inhibitor is discontinued, resume previous dose of zanubrutinib.
Moderate or strong CYP3A4 inducers (e.g. carbamazepine, phenytoin, rifampin, St John’s Wort etc.) Potentially reduced efficacy of zanubrutinib due to decreased plasma concentrations. Avoid combination if possible. Monitor patients closely for decreased zanubrutinib efficacy.
General
  Interaction Clinical management
Digoxin Anti-cancer drugs can damage the lining of the intestine; affecting the absorption of digoxin. Monitor digoxin serum levels; adjust digoxin dosage as appropriate.
Antiepileptics Both altered antiepileptic and anti-cancer drug levels may occur, possibly leading to loss of efficacy or toxicity. Where concurrent use of an enzyme-inducing antiepileptic cannot be avoided, monitor antiepileptic serum levels for toxicity, as well as seizure frequency for efficacy; adjust dosage as appropriate.
Also monitor closely for efficacy of the anti-cancer therapy.
Antiplatelet agents and NSAIDs Increased risk of bleeding due to treatment related thrombocytopenia. Avoid or minimise combination.
If combination deemed essential, (e.g. low dose aspirin for ischaemic heart disease) monitor for signs of bleeding.
Serotonergic drugs, including selective serotonin reuptake inhibitors (SSRIs e.g. paroxetine) and serotonin noradrenaline reuptake inhibitors (SNRIs e.g. venlafaxine) Increased risk of serotonin syndrome with concurrent use of 5-HT3 receptor antagonists (e.g. palonosetron, ondansetron, granisetron, tropisetron, dolasetron, etc.) Avoid combination.
If combination is clinically warranted, monitor for signs and symptoms of serotonin syndrome (e.g. confusion, agitation, tachycardia, hyperreflexia).
For more information link to TGA Medicines Safety Update.
Vaccines Diminished response to vaccines and increased risk of infection with live vaccines. Live vaccines (e.g. BCG, MMR, zoster and varicella) are contraindicated in patients on immunosuppressive therapy. Use with caution in patients on non-immunosuppressive therapy.
For more information; refer to the recommended schedule of vaccination for cancer patients, as outlined in the Australian Immunisation Handbook

eviQ provides safe and effective instructions on how to administer cancer treatments. However, eviQ does not provide every treatment delivery option, and is unable to provide a comprehensive list of cancer treatment agents and their required IV line giving set/filter. There may be alternative methods of treatment administration, and alternative supportive treatments that are also appropriate. Please refer to the individual product information monographs via the TGA website for further information.

Administration

This is a continuous oral treatment

General patient assessment prior to each day of treatment.

Zanubrutinib

  • administer orally TWICE daily
  • to be swallowed whole with a glass of water; do not open, break or chew the capsules
  • may be taken with or without food

Note: if a dose is not taken at the scheduled time, it can be taken as soon as possible on the same day, with a return to the normal schedule the following day. Treating clinicians may prescribe a ONCE daily dose.

Continue safe handling precautions (reproductive risk only) for 7 days after completion of drug(s).

Discharge information

Zanubrutinib capsules
  • Zanubrutinib capsules with written instructions on how to take them.
Antiemetics
  • Antiemetics as prescribed.
Prophylaxis medications
  • Prophylaxis medications (if prescribed) i.e. tumour lysis prophylaxis, PJP prophylaxis, antifungals, antivirals.
Patient information
  • Ensure patient receives patient information sheet.

The side effects listed below are not a complete list of all possible side effects for this treatment. Side effects are categorised into the approximate onset of presentation and should only be used as a guide.

Immediate (onset hours to days)
Headache
Nausea and vomiting

Read more about prevention of treatment induced nausea and vomiting

Early (onset days to weeks)
Neutropenia

Abnormally low levels of neutrophils in the blood. This increases the risk of infection. Any fever or suspicion of infection should be investigated immediately and managed aggressively. 

Read more about immediate management of neutropenic fever
Thrombocytopenia

A reduction in the normal levels of functional platelets, increasing the risk of abnormal bleeding.  

Read more about thrombocytopenia
Arthralgia and myalgia

Generalised joint pain or and/or stiffness and muscle aches, often worse upon waking or after long periods of inactivity. Can improve with movement. May be mild or severe, intermittent or constant and accompanied by inflammation. 

Read more about arthralgia and myalgia
Atrial fibrillation
Cardiotoxicity

Cardiotoxicity may manifest as asymptomatic reduction in left ventricular ejection fraction (LVEF), arrhythmia, cardiomyopathy, hypertension, cardiac ischaemia and congestive heart failure (CHF). The risk of cardiotoxicity is increased by a number of factors, particularly a history of heart disease and electrolyte imbalances.

Read more about cardiotoxicity associated with anti-cancer drugs
Constipation
Diarrhoea

Read more about treatment induced diarrhoea
Dizziness

Feeling faint or lightheaded, weak or unsteady. Advise patients to stand up slowly from sitting down or lying down positions and increase fluid intake if dehydrated.
Dyspnoea
Fatigue

Read more about fatigue
Fever
Fluid retention and oedema

An excess amount of fluid around the cells, tissues or serous cavities of the body, leading to swelling.
Haemorrhage
Hepatotoxicity

Anti-cancer drugs administered either alone or in combination with other drugs and/or radiation may cause direct or indirect hepatotoxicity. Hepatic dysfunction can alter the metabolism of some drugs resulting in systemic toxicity.
Hypertension

High blood pressure is commonly associated with many anti-cancer drugs. Pre-existing hypertension should be controlled prior to initiation of drugs capable of causing hypertension.
Metabolism and electrolyte imbalance

Hypocalcaemia, hypophosphataemia, hyperkalaemia or hypokalaemia, and hyperglycaemia may occur with zanubrutinib.
Respiratory tract infection
Skin rash

Anti-cancer drugs can cause a number of changes in the skin with maculo-papular rash the most common type of drug-induced skin reaction. 

Read more about skin rash

Late (onset weeks to months)
Anaemia

Abnormally low levels of red blood cells (RBCs) or haemoglobin in the blood. 

Read more about anaemia

The expert reference committee supported publication of the protocol based on the information summarised below. The committee was most strongly influenced by the outcome of the phase I/II study of zanubrutinib in B-cell malignancies, which included a cohort of patients with relapsed or refractory (RR) mantle cell lymphoma (MCL).

Source Study & Year Published Supports Use Is the dose and regimen consistent with the protocol? Comments
Phase I/II trial Tam et al. 2021r Yes Yes -
Phase II trial Song et al. 2020r Yes Yes -
Guidelines Date published/revised Supports Use Is the dose and regimen consistent with the protocol Comments
NCCN 2020r Yes Yes -
BCCA N/A N/A N/A -
CCO Oct 2021 Yes Yes Guideline for relapsed/refractory mantle cell lymphoma

Efficacy

The efficacy and safety of zanubrutinib monotherapy in RR MCL were evaluated in the BGB-3111-AU-003r and BGB-3111-206r trials, as well as in the pooled analysis of the patient-level data across these two trials.r 37 patients were enrolled in the BGB-3111-AU-003 trial with a median follow-up of 18.8 months and 86 patients were enrolled in the BGB-3111-206 trial with a median follow-up of 18.4 months. A subsequent pooled analysis of patient-level data from the two trials included 112 patients with a median follow-up of > 24 months.r

In the BGB-3111-AU-003 trial, 91% of patients had an objective response (OR) with a median time to achieving a response of 2.8 months (range 1.9-9.8 months). A total of 31% of patients achieved a complete response (CR) with a median time to CR of 5.5 months (range 1.9-11.1 months). Response to zanubrutinib was independent of baseline characteristics, including disease bulk, blastoid variant, MCL international prognostic index (MIPI), and the number of lines of previous treatment. The median progression-free survival (PFS) was 21.1 months and the overall survival (OS) rate at 12 months was 83%.r

In the BGB-3111-206 trial, 84% of patients had an OR with a median time to response of 2.7 months. The overall response rate (ORR) in patients with TP53 mutated disease (27.8% of the study cohort) was comparable to those with wild-type disease, however, the median duration of response (DOR) and PFS were shorter at 14.5 vs. 19.5 months and 14.7 vs. 22.1 months, respectively. A total of 68.6% of patients achieved CR with a median time to CR of 2.9 months. The estimated median PFS was 22.1 months with an OS rate of 84.1% at 12 months in all patients treated in this trial.r

In the pooled analysis of these two trials, the ORR was 84.8%, and the complete response rate was 62.5%. The median DOR was 24.9 months with a PFS of 25.8 months and OS of 38.2 months.r

Toxicity

A summary of the toxicities associated with this protocol are included in the table below. The most clinically significant toxicities for this treatment are infections, anaemia and bleeding.

Adverse events - mantle cell lymphomar

© Blood Advances 2021

Zanubrutinib is an oral inhibitor of Bruton’s tyrosine kinase (BTK), with higher BTK occupancy and less off-target toxicity than ibrutinib.

The primary evidence for the use of zanubrutinib in relapsed/refractory (RR) Waldenstrom macroglobulinemia (WM) or patients with previously untreated WM who are unsuitable for standard immunochemotherapy comes from a phase III randomised control trial (ASPEN). In this study, a total of 201 patients, including 164 with RR disease and 37 treatment-naive (TN) patients not suitable for standard therapy with MYD88 L265P mutation, were randomised to either ibrutinib or zanubrutinib (cohort 1) between January 2017 and July 2018. The median age was 70 years, 18 - 19% were TN and only a small proportion of patients were CXCR4WHIM mutated (8% in ibrutinib arm, 11% in zanubrutinib arm). The primary endpoint was the proportion of patients achieving a very good partial response (VGPR) – essentially a ≥90% reduction in IgM level or complete response (CR). The secondary endpoints included major response rate (MRR), duration of response (DOR), progression-free survival (PFS) and safety. The median follow-up period was 19.4 months.r

The efficacy and safety of zanubrutinib in MYD88 wildtype (MYD88WT) WM was reported in a sub-study of the phase III ASPEN trial.r In this study (cohort 2), 28 patients with WM (23 with RR disease and 5 TN patients) received zanubrutinib, of which 26 had MYD88WT, and 2 did not have sufficient material for genetic analysis. The median age of patients in cohort 2 overall was 72 years, and the median follow-up was 17.9 months. This was an exploratory study with no pre-specified primary efficacy endpoint. Endpoints included in the analysis included the proportion of patients who achieved CR, VGPR, overall response rate (ORR), MRR, PFS, overall survival (OS) and adverse events (AEs).

The safety and efficacy of long-term zanubrutinib in patients with RR and TN WM treated on a phase I/II trial (BGB3111-AU003) has also been reported.r A total of 77 patients (11 with MYD88WT) were included with a median follow-up of 37 months and 23 months in RR and TN patients respectively. The endpoints assessed included patients achieving VGPR or CR, ORR, PFS, DOR, OS and changes in markers of disease burden.

Efficacy

The frequency of WM patients with MYD88L265P mutations achieving VGPR, as determined by an independent review committee, was numerically but not significantly higher in patients treated with zanubrutinib compared to ibrutinib on the phase III ASPEN study (28% vs 19% respectively, p = 0.09). No patient achieved CR. Investigator-assessed rates of VGPR were 28% and 17% in the zanubrutinib and ibrutinib arms, respectively (p = 0.04). It should be noted that the PFS outcome for patients treated with chemoimmunotherapy is similar between patients achieving VGPR and CR. The proportion of patients achieving VGPR in intermediate or high-risk groups based on the international prognostic scoring system (IPSS) were similar.

Best overall responses seen in the ASPEN trialr

© Blood 2020

The proportion of MYD88L265P patients achieving MRR (at least a partial response with ≥ 50% reduction in IgM) was similar in those treated with zanubrutinib or ibrutinib (78% vs 80% in RR patients, 74% vs 67% in TN patients). The median time to major response for both arms was 2.8 months. The MRR was also comparable between CXCR4WHIM and CXCRWT patient subgroups with both zanubrutinib and ibrutinib. In the long-term follow-up of patients treated on the phase I/II BGB-311-AU003 study, the proportion of patients achieving VGPR/CR increased over time, with 21% of patients at six months compared to 49% of patients at 24 months, with evidence of a plateau at approximately 20 months.

Proportion of patients achieving VGPR or CR on treatment with zanubrutinibr

© Blood 2020

Patients with MYD88WT disease treated in cohort 2 of the ASPEN study, demonstrated an overall MRR of 50% and OS of 81%. The median DOR was not reached in patients who had a response on study.

27% of patients achieved VGPR, and no patient achieved CR, which is similar to the proportion of MYD88L265P patients treated with zanubrutinib in cohort 1 of the ASPEN study. Relapsed refractory patients with MYD88WT WM had a MRR of 29% when treated with single-agent rituximabr, and a VGPR rate of 33% when treated with combination rituximab and ibrutinib in the INNOVATE study.r

The median PFS was not reached for either the ibrutinib or zanubrutinib arms in MYD88L265P WM patients treated in the ASPEN study, at a median follow-up of 19 months.r The estimated OS rates at 18 months were 97% and 93%, for ibrutinib and zanubrutinib, respectively. In patients with MYD88WT disease, the median PFS was not reached at a median follow-up of 18 months and the estimated OS rate at 18 months was 88%. In the long-term follow-up of MYD88L26P and MYD88WT patients treated on the phase I/II BGB3111-AU003 study, the median PFS was not reached after a median follow-up of 37 months and 23 months for RR and TN patients, respectively.

Toxicity

The incidence of one or more serious adverse events was comparable between zanubrutinib and ibrutinib in the ASPEN study.r Infections of grade 3 or higher were similar between both treatments, although the incidence of pneumonia was higher in ibrutinib-treated patients. Bleeding at all grades occurred more frequently in ibrutinib-treated patients. Atrial fibrillation was approximately 10 times more frequent in ibrutinib-treated patients. Neutropenia was significantly more common in zanubrutinib-treated patients, with a higher proportion of patients receiving granulocyte-colony stimulating factor. Dose reduction due to adverse events was more common for ibrutinib-treated patients.

Adverse events - Waldenstrom macroglobulinaemiar

© Blood 2020

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Version 1

Date Summary of changes
15/06/2022

New protocol developed out of session as a result of TGA approval. Approved electronically by the Haematology Reference Committee. Protocol published as version number v.1. Review in 1 year.
19/07/2022 Zanubrutinib drug status updated - PBS approved for both indications.
11/11/2022 Protocol reviewed electronically by the Haematology Reference Committee, nil changes. Review in 1 years

The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information sources. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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Review due:

The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/p/4081

31 Mar 2023