News in brief: Three lymphoma drugs for PBAC consideration; Warnings on Zostavax for immunosuppressed patients; Overinvestigation of iron overload in Asian Australians

Thursday, 3 Jun 2021

Three lymphoma drugs up for PBS listing

Three lymphoma therapies are to be considered at the July meeting of the  Pharmaceutical Benefits Advisory Committee. The Leukaemia Foundation says it will be providing consumer comments to support PBS listings for acalabrutinib (Calquence) patients with relapsed/refractory mantle cell lymphoma (MCL) who had received at least one prior therapy or who had developed an intolerance to another Bruton’s tyrosine kinase (BTK) inhibitor.

It will also support a PBS listing application for selinexor (Xpovio) for the treatment of relapsed and/or refractory diffuse large B-cell lymphoma (DLBCL) in patients who have received at least two lines of systemic therapy.

An application for zanubrutinib (Brukinsa) to treat adults with Waldenström’s macroglobulinaemia (WM) will also be considered.

More warnings on Zostavax for immunosuppressed patients

The TGA has revealed the wording of new warnings for Zostavax vaccine to address the risk of fatal disseminated varicella-zoster virus infection in immunocompromised patients.

A new boxed warning has been added to the Product Information (PI) with information about managing this risk, including pre-screening and risk-based assessment prior to use of the vaccine, and management of suspected cases.

The warning states that have been several fatal cases of disseminated vaccine-related VZV infection in Australia, including in patients on low dose immunosuppressive medication, and that the risk increases with the degree of immunosuppression.

It advises that the vaccine is contraindicated in patients with current or recent severe immunocompromising conditions from either a primary or acquired medical condition or medical treatment.

“Careful pre-screening and a risk-based assessment is required prior to administration of any dose of Zostavax. If appropriate, this assessment should include medical specialist consultation and potentially screening for pre-existing antibody to VZV. In such cases, vaccination should be deferred until such advice and/or results have been obtained,” it advises.

Unnecessary testing for iron overload in Asian Australian patients

Iron overload is rare in Asian-Australian patients, in whom hyperferritinaemia is more likely to be due to other factors such as transfusion (47%), acute infection (11%) and haematological malignancy (8%), a Victorian study has shown. A retrospective review of 64 patients with a background in East, South East or South Asia found that only one (1.6%) had confirmed iron overload.

The authors of the article in Internal Medicine Journal noted that the investigation and management of hyperferritinaemia in Caucasian patients was usually guided by homozygosity of the HFE gene mutation C282Y, but this was not seen in Asian patients

“A lack of awareness among clinicians can lead to the over-investigation of HFE mutations in Asian patients,” they said.

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