Antibody-Drug Conjugate (CD79b) Pregnancy: Contraindicated — cytotoxic MMAE payload; effective contraception required during and for 9 months (female) / 6 months (male) after treatment

Polatuzumab Vedotin

Brand names: Polivy

Adult dose

Dose: 1.8 mg/kg IV every 21 days

Route: Intravenous infusion

Frequency: Every 21 days (6 cycles)

Max: 1.8 mg/kg per cycle

DLBCL first-line: with rituximab, cyclophosphamide, doxorubicin, prednisolone (Pola-R-CHP); R/R DLBCL: with bendamustine + rituximab

Paediatric dose

Dose: Not established N/A/kg

Route: N/A

Frequency: N/A

Max: N/A

Not licensed in paediatrics

Dose adjustments

Renal

No dose adjustment required

Hepatic

Avoid in moderate-severe hepatic impairment — monomethyl auristatin E (MMAE) clearance impaired

Paediatric weight-based calculator

Patient weight (kg)

Not licensed in paediatrics

Clinical pearls

POLARIX trial (Tilly et al. NEJM 2022): Pola-R-CHP significantly improved 2-year PFS vs R-CHOP in previously untreated DLBCL (76.7% vs 70.2%), without increased toxicity — first frontline DLBCL improvement in 20 years
Targets CD79b, a B-cell receptor component expressed on >90% of DLBCL — MMAE payload disrupts microtubule polymerisation causing tumour cell death
MHRA 2020 approved; NICE TA662 for R/R DLBCL with BR; NICE TA862 for first-line use in Pola-R-CHP combination
Peripheral neuropathy is cumulative and dose-limiting — baseline neurological assessment mandatory; monitor for tingling, numbness, weakness throughout
Granulocyte colony-stimulating factor (G-CSF) prophylaxis recommended due to risk of febrile neutropenia in combination regimens

Contraindications

Active severe infections
Known hypersensitivity to polatuzumab or excipients

Side effects

Peripheral neuropathy (dose-limiting)
Neutropenia
Thrombocytopenia
Fatigue
Diarrhoea
Nausea
Infusion-related reactions

Interactions

Myelosuppressive agents — additive haematotoxicity
CYP3A4 inhibitors — may increase MMAE (cytotoxic payload) exposure
Live vaccines — avoid during and for ≥6 months after treatment

Monitoring

FBC before each cycle
LFTs
Neurological assessment (neuropathy grading)
Infusion reactions (vital signs during infusion)
Infection monitoring

Reference: BNFc; BNF 90; POLARIX trial (Tilly et al. NEJM 2022); NICE TA662; NICE TA862; MHRA SPC Polivy; GO29365 trial (Sehn et al. JCO 2020). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways