Relapsed or refractory Hodgkin lymphoma - brentuximab (failed autologous stem cell transplant (ASCT) or is ASCT naïve) initial PBS authority form (PB205)

Use this form to apply for initial PBS subsidised treatment with brentuximab vedotin for relapsed or refractory Hodgkin lymphoma and who has failed ASCT or is ASCT naïve.

Download and complete the Relapsed or refractory Hodgkin lymphoma - brentuximab (failed autologous stem cell transplant (ASCT) or is ASCT naïve) initial PBS authority form.

This form can be uploaded through HPOS. Read more about form upload in HPOS.

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Page last updated: 1 October 2020