Pentostatin

How it works

It potently inhibits adenosine deaminase, causing accumulation of deoxyadenosine nucleotides that are toxic to lymphocytes.

Prescribing in practice

• It is profoundly immunosuppressive and myelosuppressive, predisposing to serious and opportunistic infection, so it must be given under specialist haemato-oncology supervision with appropriate prophylaxis.
• Adequate hydration is required around administration to support renal handling, and the dose is reduced in renal impairment.
• Concurrent use with fludarabine has been associated with severe, sometimes fatal pulmonary toxicity and is contraindicated.

Monitoring

Monitor full blood count, renal function, and for signs of infection throughout treatment.

Counselling the patient

• Report fever or any sign of infection without delay, as your immune system will be suppressed.
• Maintain good fluid intake around each treatment as advised by the team.
• Effective contraception is needed during and after treatment.

Evidence & guidelines

Pentostatin is an established option for hairy cell leukaemia supported by long-standing clinical use and trial data.