Pentostatin is a chemotherapy drug usually given 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 should ideally be read with our general information about chemotherapy and your type of cancer.
You'll see your hospital doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
What pentostatin looks like
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Pentostatin is a clear, colourless fluid.
Pentostatin is given as an injection in one of the following ways:
through a fine tube (cannula) inserted into a vein (intravenously), usually in the back of your hand
through a fine plastic tube inserted under the skin and into a vein near your collarbone (central line)
through a fine tube inserted into a vein in the crook of your arm (PICC line).
While having pentostatin you'll also be given a drip (infusion) of fluid to help keep your kidneys working normally. Pentostatin is usually given every two weeks for the treatment of hairy cell leukaemia.
Chemotherapy is given as a course of several sessions (cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer you're being treated for. Your nurse or doctor will discuss your treatment plan with you.
Before you begin your treatment, your doctor will arrange for you to have blood tests. You'll usually be given anti-sickness drugs before and/or during your treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here won't affect everyone who has pentostatin, and may be different if you're having more than one type of chemotherapy drug.
We have outlined the most common side effects, but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Pentostain can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38ºC (100.4ºF)
you suddenly feel unwell, even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising or bleeding
Pentostatin can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Pentostatin can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) and being sick (vomiting)
This may begin soon after the treatment is given and can last for 24 hours. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor - they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Your skin may feel dry and itchy. 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.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t operate or drive machinery.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight. You might find our section on eating well useful.
Pentostatin can affect your eyes. Your eyes may become dry or more watery and more sensitive to sunlight. Less commonly, treatment can cause eye pain or changes to your vision. Let your doctor know if your notice any of these changes.
Less common side effects
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Some people have ear pain or ringing in the ears (tinnitus) and may lose the ability to hear high-pitched sounds. Tell your doctor if you notice any tinnitus or loss of hearing.
Pentostatin can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Your mouth may become sore or dry, 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. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. You might find our section on mouth care during chemotherapy helpful.
An allergic reaction may occur while you're having the drip or shortly afterwards. Signs of an allergic reaction include skin rashes and itching, a high temperature (fever), shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety and a feeling that you want to pass urine. You'll 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 from the time your treatment is given, but they don’t usually last long. Your doctor may prescribe medicines to reduce these effects.
Treatment with pentostatin may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly. Your liver may be temporarily affected.
Your kidneys may be affected
This doesn't usually cause any symptoms and the effect is generally mild. However, if the effect is severe, the kidneys can be permanently damaged unless the 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 pass urine. You may be asked to drink extra fluid before and after treatment. It’s important to do this, so let your doctor know if this is a problem - for example, if you're feeling sick.
Changes to the lungs
The chemotherapy may cause some changes to the lungs. Tell your doctor if you smoke or if you notice any coughing or breathlessness.
Changes in the way your heart works
Occasionally, pentostatin may cause changes in the muscle of the heart, which can affect how the heart works. Tests to see how well your heart is working may sometimes be carried out before the drug is given.
This is rare, but your hair may thin or occasionally fall out completely. If this happens, it usually begins about 3-4 weeks after starting treatment, although it may occur earlier. This is temporary and your hair will start to grow back once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Leakage into the tissue around the vein (extravasation)
If this happens when pentostatin is being given, the tissue in that area can become damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you're at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having pentostatin, as it may harm the developing baby. It’s important to use effective contraception while having this drug and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
If you have treament with pentostatin, for the rest of of your life you should only be given blood transfusions and platelet transfusions that have been treated with radiation (irradiated). This lower the risk of the donated blood cells reacting against your own. Your hospital team should give you a card to carry or a Medicalert to wear so that hospital staff are aware in case of an emergency.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our pentostatin fact sheet, which has been compiled using information from a number of reliable sources including:
British National Formulary. 62nd edition. 2011. Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed September 2011).
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
AV Hoffbrand, et al. Essential Haematology. 5th edition. 2006. Blackwell Scientific Publications.