How to access Calquence from India, the named-patient import pathway for formulary gaps, 2026

*Clinically reviewed by Mohammad Ali, MD (US-trained physician, Chief AI Officer, Reserve Meds). Last reviewed 2026-05-17.

An Indian patient with an FDA-approved oncology indication for Calquence (acalabrutinib), where local registration or supply does not meet the need, may receive a prescription from their treating hematologist and have Calquence legally imported under the Central Drugs Standard Control Organisation (CDSCO) personal-import and named-patient framework. This guide explains the clinical context, the regulatory pathway, typical costs, indicative timing, and where Reserve Meds fits in as a US-based concierge coordinator.

The clinical situation

Calquence (acalabrutinib) is a second-generation Bruton tyrosine kinase (BTK) inhibitor developed by AstraZeneca. Calquence is a small-molecule, covalent, irreversible BTK inhibitor that binds to BTK at the C481 residue with greater target selectivity than first-generation ibrutinib. The improved kinome selectivity translates to reduced off-target inhibition of EGFR, ITK, and TEC-family kinases, which is the mechanistic basis for the lower rate of atrial fibrillation, hypertension, and bleeding seen in randomised head-to-head data versus ibrutinib.

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Calquence carries FDA approvals for chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL), and for mantle cell lymphoma in adult patients who have received at least one prior therapy. EMA authorisation covers CLL. The MCL approval in the US remains under an accelerated approval framework.

Route and dosing. Calquence is administered as oral capsule or tablet. Standard dosing is 100 mg orally twice daily, swallowed whole with water, taken approximately 12 hours apart. A maleate salt tablet formulation has been introduced that allows co-administration with proton pump inhibitors, which the original capsule formulation did not.

Baseline workup. Per the FDA label, the baseline workup before initiating Calquence typically includes CBC with differential, hepatitis B surface antigen and core antibody for reactivation risk, baseline ECG with prior atrial fibrillation history, comprehensive metabolic panel, and a documented bleeding-risk review covering anticoagulant or antiplatelet use. Your hematologist will confirm suitability and document a monitoring plan before the first dose.

Important warnings. The FDA label carries warnings for serious infections including opportunistic infections, hemorrhage, cytopenias, second primary malignancies including non-melanoma skin cancer, atrial fibrillation and flutter (less frequent than with ibrutinib but present), and hepatitis B reactivation. These are managed through CBC at regular intervals, infection vigilance, blood-pressure and rhythm surveillance, hepatitis B reactivation monitoring, and review for drug interactions (strong CYP3A inhibitors and inducers), the specifics of which your hematologist will tailor to your clinical situation.

How Calquence fits in the treatment landscape. Calquence is second-generation, head-to-head superior to Imbruvica (ibrutinib) on cardiovascular tolerability in the ELEVATE-RR trial in relapsed/refractory CLL. Brukinsa (zanubrutinib) is also second-generation. Pirtobrutinib (Jaypirca) is non-covalent and active in BTK C481-mutated resistance settings.

Is Calquence legally importable into India?

Yes. The Central Drugs Standard Control Organisation (CDSCO) operates a personal-import and named-patient import framework that allows a registered Indian medical practitioner, or an institutional importing pharmacy on the practitioner's behalf, to import a small quantity of a medicine approved by a recognised reference regulatory authority (US FDA, EMA, MHRA, PMDA, Health Canada, TGA) when the locally available channel does not meet the specific patient's clinical need.

The qualifying conditions are well-established:

• The medicine is approved by a recognised reference authority. Calquence qualifies on the basis of its FDA approval and EMA authorisation.
• No locally available alternative meets the specific patient's indication, strength, presentation, or supply situation.
• The treating physician takes clinical responsibility for the use, in writing, with a documented prescription and monitoring plan.
• Chain of custody is documented from the US source through international transit to the named dispensing facility in India.

The most common operational forms are CDSCO Form 12A (application for a personal-import licence to import a small quantity of a new drug for personal use), Form 10 (import licence for new drugs), and the institutional no-objection certificate (NOC) pathway through the dispensing hospital's Drug Controller cell. Approval is issued on a per-patient, per-cycle basis.

Calquence's regulatory status across reference jurisdictions

FDA-approved 2017 for MCL and 2019 for CLL, EMA-authorised, registered in many reference jurisdictions. India CDSCO has registered the molecule; supply for specific indications and strengths can vary at the specialty-pharmacy level.

The reference-authority anchor matters: CDSCO reviewers expect to see citation of at least one major reference authority's approval in the named-patient documentation package. For Calquence, the FDA label and the EMA EPAR document together constitute that anchor.

How the pathway works, step by step

1. Consultation with your treating hematologist. The prescribing decision is clinical. Your hematologist documents the indication, prior therapies where relevant, and the rationale for Calquence. If you are seeking a second opinion through Reserve Meds's medical-advisory network, we can coordinate that, but only your treating physician of record can issue the prescription.
2. Baseline screening. CBC with differential, hepatitis B surface antigen and core antibody for reactivation risk, baseline ECG with prior atrial fibrillation history, comprehensive metabolic panel, and a documented bleeding-risk review covering anticoagulant or antiplatelet use are confirmed and documented in the medical record. Findings that require management before initiation (uncontrolled hypertension, untreated hepatitis B, active untreated infection) are addressed first.
3. CDSCO named-patient application. Your hematologist or the importing pharmacy files the CDSCO documentation package, including the clinical rationale letter, prescription, patient identifier, product strength, requested quantity, and the chain-of-custody plan.
4. US-side sourcing under DSCSA chain-of-custody. Reserve Meds coordinates with our US-licensed specialty wholesale partner to secure Calquence from AstraZeneca's authorised distribution under the US Drug Supply Chain Security Act (DSCSA). Every transfer point is logged.
5. International shipment. Internationally tracked shipment to your named dispensing facility in India, with tamper-evident packaging and documented temperature handling where applicable.
6. Arrival and first dose. The dispensing pharmacy of record verifies the shipment against the prescription and releases the product. Your hematologist initiates therapy under your monitoring plan.
7. Ongoing coordination. Reserve Meds supports re-supply cadence aligned to your dosing schedule. Refills ship on a rolling basis once the pathway is established for your case.

What documentation your physician needs

Your hematologist will typically need to provide the following items as part of the CDSCO named-patient package:

• A clinical rationale letter confirming the diagnosis (chronic lymphocytic leukemia, mantle cell lymphoma), prior therapies where relevant, and Calquence as the indicated next step
• Verification of their Indian medical registration (state medical council or National Medical Commission, formerly MCI)
• A patient identifier, anonymised reference where privacy is preferred
• Documented pre-treatment screening consistent with the FDA label as summarised above
• The planned dosing regimen, indication-specific per the FDA label
• A monitoring plan covering the specific safety surveillance required for this drug class
• A formulary-gap justification explaining why the locally available channel does not meet this patient's clinical need
• The name and address of the named dispensing facility of record

Reserve Meds provides a physician documentation kit tailored for second-generation Bruton tyrosine kinase (BTK) inhibitor therapies, with the templates CDSCO reviewers commonly request. The kit is sent to your hematologist on request and shortens the first-time application turnaround significantly.

Typical costs and indicative timing

Reserve Meds issues a drug-only reference range at the start of intake and a transparent delivered quote once your physician's documentation is in. As an illustrative composite case, the US cash-pay reference range for a typical month of twice-daily dosing of Calquence sits in an indicative 2026 band of approximately USD 15,000 to 18,000. On an annualised basis, that equates to roughly USD 180,000 to 215,000 per year, before any indication-specific dose adjustments or ramp-up considerations.

International logistics, CDSCO documentation handling, cold-chain coordination where applicable, and Reserve Meds concierge coordination add incremental cost. The delivered quote we issue at intake itemises each line separately so your family and your physician can review the full picture before committing.

Indicative timing for the first shipment after cohort intake opens is approximately 2 to 5 weeks from the moment a complete application is submitted, assuming the documentation package is clean on first pass. Re-supply is generally faster once the pathway is established. These timelines are indicative and not guarantees.

If your clinical situation is time-sensitive, tell us at intake. We triage accordingly.

Where Reserve Meds fits in

Reserve Meds is a US-based concierge coordinator for cross-border specialty medicine. For Calquence specifically, we provide:

• Sourcing. Through our US-licensed specialty wholesale partner, operating under DSCSA chain-of-custody from AstraZeneca's authorised distribution through export.
• Documentation. A regulatory package tailored for your hematologist and for CDSCO review, including class-specific templates and the formulary-gap justification format reviewers expect.
• Logistics. Internationally tracked shipment to your named dispensing facility in India with tamper-evident packaging and documented chain of custody.
• Concierge case lead. A named point of contact for your family and your physician across the full case arc, from intake through first dose and into re-supply.

What we do not do. We are a coordinator. We are not the prescriber, not a pharmacy, and not a dispensing facility. All clinical decisions remain with your treating hematologist, and dispensing sits with the licensed Indian pharmacy of record. Reserve Meds operates on cash-pay only and does not bill insurance. If Calquence is already available to you locally for your indication and presentation, stay on the local channel.

What CDSCO actually looks at, a closer reading

Reviewers at the Central Drugs Standard Control Organisation work from a defined checklist when evaluating a personal-import or named-patient application. Understanding what the reviewer is reading from helps your hematologist prepare a package that clears on first pass:

• Reference-authority approval. The package must cite at least one major reference regulator's approval. For Calquence, the FDA prescribing information and the EMA EPAR are the typical anchors. Reserve Meds provides direct links to the most recent versions of both.
• Clinical rationale. A free-text narrative from your treating hematologist explaining the diagnosis, prior therapies where relevant, and the specific reason Calquence is the appropriate next step. CDSCO reviewers respond well to specificity: the indication code (ICD-11 or equivalent), the line of therapy, and the documentation that locally available alternatives are not suitable.
• Quantity requested. CDSCO authorises a defined quantity per application. For chronic-therapy drugs like Calquence, a typical first authorisation covers one to three months of supply, with subsequent refill authorisations issued on the same per-patient file.
• Chain-of-custody plan. The package must describe how the product moves from the US source, through international transit, to the dispensing facility of record. Reserve Meds provides the standard chain-of-custody attestation that satisfies this requirement.
• Dispensing facility of record. A named hospital pharmacy or licensed retail pharmacy with the capability to receive, store, and dispense the product against the prescription. Most major Indian tertiary centers including Tata Memorial Centre (Mumbai), AIIMS New Delhi, AIIMS Bhubaneswar, Christian Medical College Vellore, Apollo Hospitals (Chennai, Hyderabad, Delhi, Bangalore), Fortis Memorial Research Institute (Gurugram), Max Super Speciality Hospital (Delhi), Rajiv Gandhi Cancer Institute (Delhi), HCG Cancer Hospitals (Bangalore, Ahmedabad), and the Kidwai Memorial Institute of Oncology (Bangalore) have institutional experience with named-patient supply.

The CDSCO portal accepts applications online, with physical document submission to the relevant zonal office. Average first-pass turnaround for a clean package is 10 to 21 working days, with re-supply authorisations typically faster.

BTK Inhibitor-specific pitfalls Indian patients commonly encounter

Calquence sits in the BTK inhibitor class. Across BTK inhibitor therapies, the most common operational and clinical issues we see in Indian named-patient cases are:

• PPI co-medication with the original capsule formulation reduces absorption. The maleate-salt tablet formulation does not have this restriction, so verify which formulation your physician is prescribing.
• Anticoagulation interaction: bleeding risk is lower than with ibrutinib but still requires a surgical pause of 3 to 7 days before and after procedures.
• Atrial-fibrillation surveillance: lower rates than ibrutinib but still present. Baseline ECG and prior-history review are required.
• Hepatitis B reactivation: HBsAg and anti-HBc testing is mandatory before initiation.
• Strong CYP3A inhibitor and inducer interactions require dose adjustment or substitution.

Reserve Meds includes a class-specific operational checklist in the documentation kit we provide to your hematologist, addressing each of these items so they are handled at the start of therapy rather than discovered during a complication.

How Calquence sits against alternatives in the same line of therapy

The following table summarises how Calquence compares with the principal alternatives your hematologist may consider for the same or adjacent indications. The choice between agents is a clinical decision your hematologist owns; this comparison is provided for orientation, not as treatment guidance.

Preparing for your first dose, a patient-side checklist

Patients and families coordinating cross-border supply through Reserve Meds typically have an easier first-dose experience when the following are in place before the product arrives:

• A treating hematologist of record in India with documented prescribing decision and a monitoring plan in writing.
• A named dispensing facility (hospital pharmacy or licensed retail pharmacy) that has confirmed it will accept the named-patient import and release the product against the prescription.
• Baseline laboratory and imaging already completed within the window the FDA label specifies for Calquence.
• A primary contact in the family (typically an adult child or spouse) who can hold continuous email and phone communication with the Reserve Meds case lead across the case arc.
• Identification and address documentation required by the dispensing facility for the patient of record.
• Payment readiness for the delivered quote, with bank wire or international card payment confirmed before scheduling shipment.
• A plan for ongoing supply once the first authorisation is in hand. Refills require continuous communication between your hematologist, Reserve Meds, and the dispensing facility.

The Reserve Meds case lead walks each item with the family at intake. Where any item is open, we sequence the case so the open item is closed before shipment is scheduled, not discovered at customs.

Family and caregiver considerations

Cross-border specialty therapy is rarely a single-person decision. Reserve Meds is set up to communicate with a named primary contact (typically an adult family member) alongside the patient. We do not communicate with the family without the patient's documented authorisation, but in practice, families who handle logistics together tend to have smoother coordination. Topics commonly worth discussing as a family before initiation include:

• The realistic duration of therapy and the cost profile across that duration, not just the first month
• Travel and work implications for the patient if monitoring visits are frequent in the first weeks
• Who manages the dispensing-facility relationship and who manages the Reserve Meds case lead relationship
• The contingency plan if a re-supply authorisation is delayed: bridge supply through the dispensing facility, dose holds per the hematologist's instructions, and the threshold at which the family escalates
• Confidentiality preferences: how much detail about the case the family wants shared with extended relatives, employers, or community contacts

These conversations are easier before therapy starts. Reserve Meds can join the conversation on the family's invitation, and we can route to a Reserve Meds counselor for the operational decisions that do not require clinical judgement.

What insurance and corporate health plans will and will not do

The default posture for named-patient imports is cash-pay. Reserve Meds does not bill insurance and does not process claims on the family's behalf. Some Indian private insurance plans and corporate health plans do reimburse named-patient imports on a pre-authorisation, case-by-case basis when the documentation package is strong. The factors that increase the probability of reimbursement are:

• A clear formulary-gap justification documented by the treating hematologist
• Citation of FDA approval and EMA authorisation for Calquence for the specific indication
• Cost-comparison documentation showing the cross-border total-cost-delivered against the locally available alternative (where one exists)
• A prior-authorisation submission timed before the first shipment, with the insurer's response documented

Reserve Meds supplies the documentation that family-side submissions need but does not interact with the insurer directly. Families should plan for the cash-pay path and treat insurance reimbursement as a probability-weighted bonus, not a sure thing.

Frequently asked

Is this legal in India? Yes, when executed through the Central Drugs Standard Control Organisation (CDSCO) personal-import and named-patient framework, with appropriate documentation, clinical rationale from a registered Indian medical practitioner, and a licensed dispensing pharmacy of record. The pathway is routinely used across oncology, rare disease, and immunology at Indian tertiary centers including Tata Memorial, AIIMS, and major private oncology networks.

How does Calquence compare to Imbruvica and Brukinsa? Calquence is a second-generation BTK inhibitor. In the ELEVATE-RR head-to-head trial in previously treated CLL, acalabrutinib was non-inferior to ibrutinib on progression-free survival with statistically lower rates of atrial fibrillation, hypertension, and bleeding. Brukinsa (zanubrutinib) is also second-generation. Choice between them is a clinical decision based on cardiac history, drug interactions, and prior exposure.

Which CDSCO forms does my physician need? The most common forms are CDSCO Form 12A (application for a personal-import licence to import a small quantity of a new drug for personal use) and Form 10 (import licence for new drugs). For institutional named-patient supply, hospitals coordinate through their Drug Controller cell to issue the supporting NOC (no-objection certificate) and chain-of-custody plan. Reserve Meds provides physician-facing templates that match the format CDSCO reviewers expect.

Will my private health insurance cover this? Cash-pay is the default posture for named-patient imports. Some Indian private insurance plans and corporate health plans review case-by-case on a pre-authorisation basis when the documentation package is strong. We supply documentation for your submission but do not process insurance claims and do not bill insurers.

How long does CDSCO approval take? Indicative timing for the first shipment after cohort intake opens is approximately 2 to 5 weeks from the moment a complete application is submitted, assuming the documentation package is clean on first pass. Re-supply is generally faster once the pathway is established for that patient. These timelines are indicative and not guarantees.

What if my physician has not filed a named-patient request before? Named-patient import is an institutional process most major Indian tertiary centers have encountered. Our documentation kit is written for first-time applicants and tracks what CDSCO reviewers commonly ask for. We coordinate with the importing pharmacy directly so the clinical team is not the project manager.

How this guide is reviewed and kept current

Every Reserve Meds access guide is built and maintained through a defined review pipeline. The pipeline has four layers:

• Source ingestion. The FDA prescribing information, the EMA EPAR, the manufacturer's published label, and at least one peer-reviewed primary trial publication are pulled and pinned to a specific version for each drug.
• Clinical-content review. An AI-assisted clinical review layer cross-references the FDA label against the EMA EPAR and the peer-reviewed primary literature, flagging any divergence between authorities. Divergences are escalated to the Reserve Meds clinical team for adjudication before the guide publishes.
• Regulatory-pathway review. An AI-assisted regulatory review layer cross-references the CDSCO personal-import and named-patient framework with the current CDSCO public guidance documents, and flags any change to the framework that would alter the operational steps.
• Editorial and accessibility review. A final pass enforces Reserve Meds editorial standards (medical accuracy, no over-promising on outcomes, clear delineation of what Reserve Meds does and does not do) and accessibility conformance (WCAG 2.1 AA where applicable).

The publication date and the last-reviewed date are both surfaced at the top of every guide. Drug-class and country-pathway changes drive update cycles; the typical refresh cadence is every 90 days or sooner if a material regulatory or label change is published.

The Hindi-language version of this guide

This guide is also published in Hindi for patients and families who prefer to read clinical and regulatory material in Hindi. The Hindi version covers the same scope (clinical context, CDSCO named-patient pathway, costs, timing, Reserve Meds's role) and is reviewed by the Reserve Meds AI Language Team's Hindi medical linguist alongside the clinical and regulatory team. You can switch to the Hindi version at any time using the language link in the page header, or directly at the URL referenced in this guide's machine-readable hreflang metadata.

Arabic and Urdu versions are in production and will be linked from the same hreflang quartet once published. The English, Hindi, Arabic, and Urdu pages will all point to the same canonical resource so that search engines and assistive technologies treat them as a single multilingual entity.

If your situation does not fit this pathway

The named-patient import pathway suits a specific situation: an Indian patient with a clear clinical indication, a treating physician of record, and a local-supply gap. If your situation is different, other Reserve Meds resources may be more relevant:

• If the drug is locally registered and available for your indication at acceptable cost, stay on the local channel. We say this in every guide because it is genuinely the right answer for many patients.
• If you do not yet have a treating physician of record, the prescribing decision needs to come first. Reserve Meds can coordinate a second opinion through our medical-advisory network for cases that need orientation, but only your treating physician can issue the prescription.
• If you are not in India but have family there managing the case, that family member typically becomes the named primary contact, with the patient retaining decision-making authority on the case.
• If you are seeking access for a child or adolescent, pediatric considerations depend on the specific drug and indication. Our case lead reviews pediatric cases with extra documentation steps before proceeding.
• If your situation involves an investigational or off-label use, that sits outside the named-patient framework and typically requires either a clinical-trial pathway or an expanded-access protocol. Reserve Meds is not the right path for those situations.

Operational risks we flag at intake

Several operational risks recur in cross-border specialty cases. Reserve Meds raises each at intake and works through them with the family before scheduling shipment:

• Documentation gaps. Incomplete or inconsistent documentation is the single most common cause of CDSCO application delays. Our documentation kit is designed to close these gaps on first pass.
• Dispensing-facility readiness. The named dispensing facility must be ready to receive, store, and release the product. We confirm readiness in writing before shipment.
• Cold-chain integrity. Where the drug requires temperature control, every transfer point is monitored and logged. A cold-chain breach is grounds to reject the shipment.
• Payment timing. Payment readiness is confirmed at the start of shipment, not at arrival. International wire timing varies by sending bank; we plan around the longer timeline.
• Communication continuity. Case leads and family contacts can both have absences (travel, illness, religious observance). Reserve Meds maintains a backup case-lead pattern so coordination does not pause.
• Re-supply timing. Refills are scheduled so the patient never has a dosing gap. We work backwards from the patient's last-dose date to ensure new supply lands with a comfortable margin.

Authoritative sources cited on this page

This guide is built on primary regulatory and peer-reviewed sources. Key citations:

1. U.S. FDA - CALQUENCE prescribing information (U.S. Food and Drug Administration)
2. AstraZeneca - Calquence product page (AstraZeneca)
3. European Medicines Agency - Calquence EPAR (European Medicines Agency)
4. Byrd JC et al, Acalabrutinib versus ibrutinib in previously treated chronic lymphocytic leukemia (ELEVATE-RR), J Clin Oncol 2021 (American Society of Clinical Oncology)
5. Central Drugs Standard Control Organisation (India) (Central Drugs Standard Control Organisation)

The full machine-readable citation block is in the JSON-LD CreativeWork node above. Methodology and limitations of the review process are documented at Trust and Compliance.

Mechanism of action, deeper reading

For patients and family members who want to understand more about how this drug works at the molecular level, the following points expand on the high-level mechanism summary above:

• Calquence is a covalent, irreversible BTK inhibitor with selectivity for BTK over off-target kinases such as EGFR, ITK, and TEC.
• The selectivity profile is the mechanistic basis for the lower rates of atrial fibrillation, bleeding, and hypertension seen in head-to-head data against ibrutinib.
• Binding occurs at the same C481 cysteine residue as ibrutinib, so C481S mutation confers cross-resistance.
• Like ibrutinib, acalabrutinib blocks BCR signaling through PLC-gamma2 and PKC-beta, removing the survival signal in malignant B-cell clones.
• Acalabrutinib has been associated with less tissue penetration into certain compartments (a possible explanation for differential efficacy in some MCL settings); the maleate-salt tablet formulation removes the PPI restriction of the original capsule.

Key trials that built the evidence base

The clinical evidence supporting the use of this drug across its approved indications comes from a defined set of randomised trials. The principal trials are summarised below; your treating physician will know the trial design and patient-population details relevant to your specific situation:

Glossary

CDSCO

Central Drugs Standard Control Organisation, India's national drug regulatory authority.

Named-patient import

A regulatory pathway that allows import of an unregistered or locally unavailable medicine for an individual patient under their physician's responsibility.

DSCSA

Drug Supply Chain Security Act, the US law that requires chain-of-custody tracking from manufacturer through dispensing pharmacy.

Reference authority

A major regulatory authority whose approval CDSCO will recognise as evidence of safety and efficacy. US FDA, EMA, MHRA, PMDA, Health Canada, and TGA are the principal reference authorities.

Formulary gap

A documented mismatch between what is available in the local market and what the patient's clinical situation requires. The formulary-gap justification is a core element of the CDSCO named-patient application.

Concierge coordinator

A non-prescribing, non-dispensing service that coordinates sourcing, documentation, and logistics for cross-border specialty medicine, while clinical decisions remain with the treating physician and dispensing remains with the licensed pharmacy.

Related pages on Reserve Meds

• Calquence in India - drug overview and matrix cell
• Chronic lymphocytic leukemia
• Leukemia overview
• Named-patient program pathway
• Compassionate use pathway
• Cross-border prescription pathway
• All access guides
• India country guide

Recent regulatory and access news for Calquence in India

The CDSCO Notifications feed at cdsco.gov.in/Notifications has not posted a Calquence-specific notification over the last 12 months as of 2026-06-04. The Drugs Controller General of India has not added Calquence to the Approved New Drugs list at cdsco.gov.in Approved-New-Drugs. The National Pharmaceutical Pricing Authority database at nppaindia.nic.in and the Pharmacovigilance Programme of India at ipc.gov.in have not registered Calquence-specific signals. AstraZeneca continues commercial rollout of acalabrutinib, a second-generation BTK inhibitor for chronic lymphocytic leukemia and mantle cell lymphoma. We update this section on each case file at intake; the snapshot date governs.

Next step

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Composite case examples. This content is for general information and does not constitute medical advice.

Clinical and regulatory review: Mohammad Ali, MD (US-trained physician, Chief AI Officer, Reserve Meds). Last medically reviewed: 2026-05-17.