Pentostatin (Nipent®)
Pentostatin (pronounced pen-toe-stat-in), is a chemotherapy drug that is given as a treatment for some types of leukaemia. It is most commonly used to treat a type of leukaemia called hairy cell leukaemia. It may be used as part of research trials to treat other types of cancer such as cutaneous T-cell lymphoma. This information describes pentostatin, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of leukaemia or lymphoma.
If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
What pentostatin looks like
Pentostatin is a clear, colourless fluid after being dissolved from powder.
How it is given
Pentostatin is given by injection:
- into a vein (intravenously) through a fine tube (cannula) placed into the vein
- through a fine plastic tube which is inserted under the skin into a vein near the collarbone (central line) or passed through a vein in their arm (PICC line).
While having pentostatin you will also be given a drip (infusion) of fluid to help keep your kidneys working normally.
Possible side effects
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given pentostatin.
We have outlined the most common side effects and those which are less common, so that you can be aware of them if they occur. However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you do notice any effects that you think may be due to the drug, but that are not listed in this information, please discuss these with your doctor or chemotherapy nurse.
Lowered resistance to infection Pentostatin can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
- Your temperature goes above 38ºC (100.5ºF)
- You suddenly feel unwell (even with a normal temperature).
You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.
Bruising or bleeding Pentostatin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.
Anaemia (low number of red blood cells) While having treatment with pentostatin you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.
Nausea and vomiting If this happens it may begin a few hours after the treatment is given and last for up to a day. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or substantially reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.
Skin changes Your skin may feel dry and may itch. Some people notice spots (like acne) on their face or upper body. This usually returns to normal a few months after the treatment has finished. Using a gentle or unperfumed moisturiser on dry areas can help. A skin rash may occur when you first start the treatment but may not happen again as your treatment continues.
Lethargy and fatigue You may suffer from fatigue. It is important to allow yourself plenty of time to rest.
Loss of appetite A dietitian or specialist nurse at your hospital can give advice on boosting your appetite, coping with eating difficulties and maintaining weight.
Gritty eyes can occur due to inflammation of the lining (conjunctiva) of the eyelids. If this happens it is important to tell your doctor, who can prescribe soothing eye drops.
Less common side effects
Diarrhoea This can usually be controlled with anti-diarrhoea medicines but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you do have diarrhoea.
Mouth sores and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.
Allergic reaction An allergic reaction may occur while you are having the drip or shortly afterwards. Signs of an allergic reaction include skin rashes and itching, high temperature, shivering, reddening of the face, dizziness, headache, breathlessness, anxiety and a feeling that you want to pass urine. You will be monitored for any signs of an allergic reaction while your treatment is being given. Tell your doctor or nurse if you have any of these.
Fever and chills These may occur with pentostatin but they do not usually last long. Your doctor may prescribe medicines to reduce these effects.
Your liver may be temporarily affected Pentostatin may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. This is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to monitor your liver and check that it is working properly.
Your kidneys may be affected Usually this does not cause any symptoms, and the effect is usually mild, but if the effect is severe the kidneys can be permanently damaged unless treatment is stopped. For this reason your kidneys will be checked by a blood test before each treatment. If necessary, you may be given medicine to help you to pass urine. If you are asked to drink extra fluid it is important to do this, or to let your doctor know if you find this difficult, perhaps because you are feeling sick.
Changes to the lungs Higher doses of pentostatin may cause some changes to lung tissue. Tell your doctor if you notice any coughing or breathlessness.
Changes in the way your heart works Higher doses of pentostatin may cause changes in the muscle of the heart. This can affect how the heart works. The effect on the heart depends on the dose given. It is very unusual for the heart to be affected if you receive standard doses. Tests to see how well your heart is working may sometimes be carried out before the drug is given.
Hair loss Hair loss is rare but hair may thin, or occasionally be lost completely. If this occurs it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. It is temporary and your hair will return to normal once the treatment is finished.
Additional information
If pentostatin leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell the doctor or nurse.
If the area around the injection site becomes red or swollen at any time you should either notify the doctor or nurse on the ward, or if at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Other medicines Some other medicines can be harmful when you are having chemotherapy. Tell your doctor about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while taking pentostatin, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.
