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Medications listed are available on OH EPIC Formulary, unless otherwise noted.
Not all formulary medications are available at each facility. Please refer to your local pharmacy for available inventory.
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loncastuximab tesirine

loncastuximab tesirine
Drug Name Form Strength Infusion Center Available Restricted Non-formulary Ambulatory Available Interchange REMS
Zynlonta INJECTION, INTRAVENOUS 10 mg        
VIEW MORE Antineoplastic Agents
CLASS
100000
High Alert Drug : Policy
Additional Information and Links

OH Formulary Restrictions:

  • Indication: loncastuximab tesirine-lpyl (Zynlonta) is indicated for the treatment of adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy.
  • Formulary location: Outpatient Infusion
  • Service Line: Oncology
  • Service Location: Infusion Center
  • Prior Authorization Required: Yes
  • Criteria of Use/Restriction:
    • Restricted to BEACON treatment protocol
    • Patient 18 years of age or older
    • Adult patients with relapsed or refractory large B-cell lymphoma, including DLBCL not otherwise specified, DLBCL arising from low grade lymphoma, and high-grade B-cell lymphoma
      • Must have previously received two or more lines of systemic therapy
      • If any patient previously received CD-19 directed therapy (e.g., tafasitamab), it is required to have a biopsy showing CD-19 expression
      • Must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
Last updated: Mar. 21, 2024

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