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How it is administered
Pentostatin is supplied as a sterile, lyophilized powder for intravenous (IV) administration. Each vial contains 10 mg of pentostatin. The medication is reconstituted with sterile water and can be administered either by IV bolus injection or diluted in a larger volume and infused over 20 to 30 minutes. Hydration with IV fluids before and after administration is recommended to help protect the kidneys.
How it works
Pentostatin is a potent inhibitor of the enzyme adenosine deaminase (ADA), which is especially active in lymphoid cells. By blocking ADA, pentostatin causes a buildup of certain molecules inside cells, leading to an increase in dATP. This buildup interferes with DNA synthesis and can also inhibit RNA synthesis and increase DNA damage. These effects are particularly toxic to certain blood cancer cells, such as those found in hairy cell leukemia. The precise way pentostatin works against hairy cell leukemia is not fully understood, but its ability to disrupt DNA and RNA synthesis in cancerous lymphocytes is key to its effectiveness.
Common side effects
- Nausea and/or vomiting
- Fever
- Rash
- Fatigue
- Leukopenia (low white blood cell count)
- Pruritus (itching)
- Cough
- Myalgia (muscle pain)
- Chills
- Headache
- Diarrhea
- Abdominal pain
- Anorexia
- Upper respiratory infection
- Asthenia (weakness)
- Stomatitis (mouth sores)
- Rhinitis (nasal inflammation)
- Dyspnea (shortness of breath)
- Anemia
- Pain
- Pharyngitis (sore throat)
- Sweating
- Viral infection
- Arthralgia (joint pain)
- Thrombocytopenia (low platelets)
- Skin disorders
- Allergic reactions
- Elevated liver function tests
Serious but less common side effects include severe infections, kidney problems, nervous system toxicity, and severe skin reactions.
Who Should take it
Pentostatin is indicated for adults with hairy cell leukemia, including those who have not been treated before and those whose disease did not respond to or worsened after treatment with alpha-interferon. It is used in patients with active disease, which means those experiencing symptoms or low blood counts (anemia, neutropenia, or thrombocytopenia) due to the leukemia.
Who should not take it
Pentostatin should not be taken by anyone who has had a hypersensitivity (allergic) reaction to pentostatin. It should be used with caution in patients with active infections, as it can worsen these conditions. Pregnant women should not take pentostatin because it can cause harm to the unborn baby. Its safety in children and adolescents has not been established. Patients with impaired kidney function should only receive pentostatin if the potential benefit outweighs the risk, and the dose may need to be adjusted.
Commonly used with
Pentostatin is generally used as a single agent for hairy cell leukemia. It is not commonly combined with other chemotherapy drugs for this condition, as combination therapy can increase the risk of severe side effects.
Commonly tested with
Pentostatin has been compared to alpha-interferon (IFN) in clinical studies for hairy cell leukemia. It has also been tested in combination with other chemotherapy agents (such as carmustine, etoposide, and high-dose cyclophosphamide) in bone marrow transplant regimens, but this combination has been associated with serious and sometimes fatal side effects. The combination with fludarabine is not recommended due to increased risk of fatal lung toxicity.
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