Pentostatin

Pentostatin is used to treat a certain type of cancer (hairy cell leukemia). It works by slowing or stopping the growth of cancer cells. It is used off-label to treat chronic lymphocytic leukemia (CLL), chronic myelogenous leukemia (CML), and cutaneous T-cell lymphoma.

Pentostatin is available under the following different brand names: Nipent, DCF, and 2Deoxycoformycin.

Dosages of Pentostatin:

Dosage Forms and Strengths

Powder for Injection

• 10 mg/vial

Dosage Considerations – Should be Given as Follows:

Hairy Cell Leukemia

• 4 mg/m² intravenously (IV) (bolus or infusion) every 2 weeks
• Monitor: complete blood count (CBC), serum creatinine

Other Indications and Uses

• Off-label: chronic lymphocytic leukemia (CLL), chronic myelogenous leukemia (CML), cutaneous T-cell lymphoma

Safety and efficacy not established in pediatric patients.

Common side effects of Pentostatin include:

• Nausea/vomiting
• Fever
• Rash
• Fatigue
• Low white blood cell count (leukopenia)
• Itching
• Cough
• Chills
• Muscle pain
• Diarrhea
• Headache
• Abdominal pain
• Loss of appetite
• Upper respiratory infection
• Weakness/lethargy
• Inflammation of the mouth and lips
• Shortness of breath
• Runny nose
• Immune hypersensitivity reaction
• Neurotoxicity

Less common side effects of pentostatin include:

• Low blood sodium (hyponatremia)
• Renal failure
• Pain
• Pharyngitis
• Low platelets (thrombocytopenia)
• Anemia
• Joint pain
• Elevated liver function tests
• Hypersensitivity
• Skin disorders
• Sweating
• Viral infections

Other side effects of pentostatin include:

• Microangiopathic hemolytic anemia
• Thrombotic thrombocytopenic purpura
• Febrile neutropenia
• Hemolytic uremic syndrome
• Thrombotic thrombocytopenic purpura
• Autoimmune thrombocytopenia
• Acute respiratory failure
• Exfoliative dermatitis

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Severe interactions of pentostatin include:
  • fludarabine
• Serious interactions of pentostatin include:
  • adenovirus types 4 and 7 live, oral
  • deferiprone
  • influenza virus vaccine trivalent, adjuvanted
  • palifermin
  • pegademase
  • tofacitinib
• Moderate interactions of pentostatin include:
  • acalabrutinib
  • altretamine
  • belatacept
  • betrixaban
  • cholera vaccine
  • dengue vaccine
  • denosumab
  • fingolimod
  • hydroxyurea
  • influenza virus vaccine (H5N1)
  • influenza virus vaccine (H5N1), adjuvanted
  • meningococcal group B vaccine
  • olaparib
  • siponimod
  • sipuleucel-T
  • tobramycin inhaled
  • trastuzumab
• Mild interactions of pentostatin include:
  • maitake
  • taurine
  • vitamin A
  • vitamin E

Warnings

• This medication contains pentostatin. Do not take Nipent, DCF, or 2Deoxycoformycin if you are allergic to pentostatin or any ingredients contained in this drug.

Black Box Warnings

• The drug should be administered under the supervision of an experienced cancer chemotherapy physician in a facility equipped to diagnose and manage complications
• Do not exceed recommended doses. Nephrotoxicity, hepatotoxicity, central nervous system (CNS), and pulmonary toxicity occurred in phase 1 studies that used higher doses than recommended
• Do not use with concurrent fludarabine because of increased risk of pulmonary toxicity

Contraindications

• Hypersensitivity
• Concomitant fludarabine: risk of fatal pulmonary toxicity
• Relative: active infections

Effects of Drug Abuse

• No information is available.

Short-Term Effects

• See "What Are Side Effects Associated with Using Pentostatin?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Pentostatin?"

Cautions

• Epilepsy, liver disease, bone marrow depression
• Weigh risk/benefit for patients with infections
• Withhold if elevated serum creatinine, renal dysfunction
• Withhold or discontinue if evidence of CNS toxicity
• Avoid pregnancy

Pregnancy and Lactation

• Use pentostatin during pregnancy only in LIFE-THREATENING emergencies when no safer drug is available. There is positive evidence of human fetal risk.
• It is not known if pentostatin is excreted in breast milk. Breastfeeding is not recommended while using pentostatin.