Acute lymphoblastic leukaemia first line - dasatinib - initial (induction and consolidation) authority application form (PB271)

Use this form to apply for initial (induction and consolidation) PBS-subsidised therapy with dasatinib in the first-line treatment of acute lymphoblastic leukaemia.

You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology or need an interpreter.

You can upload this form in HPOS.

Please note: You don’t need to complete this form if you use the Online PBS Authorities system.

Download and complete the acute lymphoblastic leukaemia first line - dasatinib - initial (induction and consolidation) authority application form.

Page last updated: 1 March 2026.
QC 51325