No

Antineoplastic Agent, Antibiotic

Treatment of adult patients with alpha-interferon-refractory hairy cell leukemia; non-Hodgkin's lymphoma, cutaneous T-cell lymphoma

D

Limited or severely compromised bone marrow reserves (white blood cell count <3000 cells/mm³)

The FDA currently recommends that procedures for proper handling and disposal of antineoplastic agents be considered. Pregnant women or women of childbearing age should be apprised of the potential risk to the fetus; use extreme caution in the presence of renal insufficiency; use with caution in patients with signs or symptoms of impaired hepatic function.

>10%:

Central nervous system: Headache, neurologic disorder, fever, fatigue, chills, pain

Dermatologic: Rash

Gastrointestinal: Vomiting, nausea, anorexia, diarrhea

Hematologic: Leukopenia, anemia, thrombocytopenia

Hepatic: Hepatic disorder, abnormal LFTs

Neuromuscular & skeletal: Myalgia

Respiratory: Coughing

Miscellaneous: Allergic reaction

1% to 10%:

Cardiovascular: Chest pain, arrhythmia, peripheral edema

Central nervous system: Anxiety, confusion, depression, dizziness, insomnia, lethargy, coma, seizures, malaise

Dermatologic: Dry skin, eczema, pruritus

Gastrointestinal: Constipation, flatulence, stomatitis, weight loss

Genitourinary: Dysuria

Hematologic: Myelosuppression

Hepatic: Liver dysfunction

Local: Thrombophlebitis

Neuromuscular & skeletal: Arthralgia, paresthesia, back pain, weakness

Ocular: Abnormal vision, eye pain, keratoconjunctivitis

Otic: Ear pain

Renal: Renal failure, hematuria

Respiratory: Bronchitis, dyspnea, lung edema, pneumonia

Miscellaneous: Death, opportunistic infections, diaphoresis

Symptoms of overdose include severe renal, hepatic, pulmonary, and CNS toxicity

Supportive therapy

Increased toxicity: Vidarabine, fludarabine, allopurinol

Vials are stable under refrigeration at 2°C to 8°C; reconstituted vials, or further dilutions, may be stored at room temperature exposed to ambient light; diluted solutions are stable for 24 hours in D₅W or 48 hours in NS or lactated Ringer's at room temperature; infusion with 5% dextrose injection USP or 0.9% sodium chloride injection USP does not interact with PVC-containing administration sets or containers

An antimetabolite inhibiting adenosine deaminase (ADA), prevents ADA from controlling intracellular adenosine levels through the irreversible deamination of adenosine and deoxyadenosine. ADA is found to exhibit the highest activity in lymphoid tissue. Patients receiving pentostatin accumulate deoxyadenosine (dAdo) and deoxyadenosine 5'-triphosphate (dATP); accumulation of dATP results in cell death, probably through inhibiting DNA or RNA synthesis. Following a single dose, pentostatin has the ability to inhibit ADA for periods exceeding 1 week.

Distribution: I.V.: V_d: 36.1 L (20.1 L/m²); distributes rapidly to body tissues and may obtain plasma concentrations ranging from 12-36 ng following doses of 250 mcg/kg for 4-5 days

Half-life, terminal: 5-15 hours

Elimination: ~50% to 96% is recovered in urine within 24 hours

Refractory hairy cell leukemia: Adults (refer to individual protocols): 4 mg/m² every other week; I.V. bolus over greater than or equal to 3-5 minutes in D₅W or NS at concentrations greater than or equal to 2 mg/mL

Cl_cr <60 mL/minute: Use extreme caution

Cl_cr 50-60 mL/minute: 2 mg/m²/dose

Sedation is common; may cause anxiety, confusion, insomnia, depression

Leukopenia is common; avoid clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

This drug can only be administered by infusion on a specific schedule. Frequent blood tests and monitoring will be necessary. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience nausea and vomiting, diarrhea, or loss of appetite (frequent small meals or frequent mouth care may help or request medication from prescriber); dizziness, weakness, or lethargy (use caution when driving); susceptibility to infections (avoid crowds and exposure to infection). Use frequent oral care with soft toothbrush or cotton swabs to reduce incidence of mouth sores. May cause headache (request medication). Report signs of infection (eg, fever, chills, sore throat, mouth sores, burning urination, perianal itching, or vaginal discharge); unusual bruising or bleeding (tarry stools, blood in urine, stool, or vomitus); vision changes or hearing; muscle tremors, weakness, or pain; CNS changes (eg, hallucinations, confusion, insomnia, seizures); or respiratory difficulty. Pregnancy/breast-feeding precautions: Do not get pregnant while taking this medication. Both male and female should use appropriate barrier contraceptive measures. Do not breast-feed.

Powder for injection: 10 mg/vial

Brogden RN and Sorkin EM, "Pentostatin. A Review of Its Pharmacodynamic and Pharmacokinetic Properties, and Therapeutic Potential in Lymphoproliferative Disorders," Drugs, 1993, 46(4):652-77.

Catovsky D, "Clinical Experience With 2'-Deoxycoformycin," Hematol Cell Ther, 1996, 38(Suppl 2):S103-7.

Dillman RO, "A New Chemotherapeutic Agent: Deoxycoformycin (Pentostatin)," Semin Hematol, 1994, 31(1):16-27.

Jeffrey LP, Chairman, National Study Commission on Cytotoxic Exposure. Position Statement. "The Handling of Cytotoxic Agents by Women Who Are Pregnant, Attempting to Conceive, or Breast-Feeding," January 12, 1987.

Kane BJ, Kuhn JG, and Roush MK, "Pentostatin: An Adenosine Deaminase Inhibitor For the Treatment of Hairy Cell Leukemia," Ann Pharmacother, 1992, 26(7-8):939-47.

Spiers AS, "The Role of Pentostatin (2'-Deoxycoformycin, dCF) in the Management of Lymphoproliferative Malignancies," Blood Rev, 1987, 1(2):106-10.