Chronic myeloid leukaemia Ponatinib - Initial PBS authority application Supporting information form (PB171)

Use this form for a patient starting initial Pharmaceutical Benefits Scheme (PBS) subsided treatment with ponatinib for the treatment of chronic myeloid leukaemia expressing the Philadelphia chromosome or the transcript BCR-ABL tyrosine kinase, who has failed an adequate trial of dasatinib and nilotinib or has developed necessitating permanent treatment withdrawal or who is expressing the T315i mutation and who has failed an adequate trial of imatinib or nilotinib.


Page last updated: 5 February 2016

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