Pentostatin (Nipent)

Pentostatin is a chemotherapy drug mainly used to treat hairy cell leukaemia. You may have it for some other types of leukaemia and lymphoma.

Pentostatin is one of a group of chemotherapy drugs known as anti metabolites. These stop cells making and repairing DNA. Cancer cells need to make and repair DNA so that they can grow and multiply.

Pentostatin is a clear liquid that you have as an injection through a fine tube (cannula) put into one of your veins (intravenously). Or you may have it through a central line that goes into a vein near your collarbone.

You usually have pentostatin chemotherapy as a course of several cycles of treatment. The treatment plan depends on which type of cancer you are having it for. There is more about how doctors plan chemotherapy in CancerHelp UK.

The side effects of pentostatin are listed below. You can use the links to find out more about each side effect. Or go to the cancer drug side effects section.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment finishes
• Feeling or being sick is usually moderate and most likely to start within 12 to 15 hours after having treatment – it is usually easily controlled with anti sickness injections and tablets so tell your doctor or nurse if you still have sickness
• A skin rash can happen with your first treatment and affects about 1 in 3 people (30%)
• Pentostatin may harm a developing baby and it is not advisable to become pregnant or father a child if you are having this drug – so talk about contraception with your doctor before having the treatment if there is any chance you or your partner could become pregnant
• You should not breastfeed while having this drug as it may come through in the breast milk
• Loss of appetite

Between 1 and 10 in every 100 people have one or more of these.

• Liver changes that will go back to normal when treatment ends – your doctor will take regular blood tests to check how your liver is working
• Diarrhoea – drink plenty of fluids and tell your doctor or nurse if it becomes severe or lasts more than a couple of days as you could get dehydrated
• A cough
• You may have sleep problems, tiredness and depression due to the effect of pentostatin on the central nervous system

Fewer than 1 in 100 people have these.

• Kidney problems are usually very mild, but tell your doctor if you are passing less urine than usual or have swelling in your ankles and feet – your doctor will do regular blood tests to check how your kidneys are working
• An allergic reaction is very rare but tell your doctor or nurse straight away if you have muscle aches, fever or chills
• Headaches
• Sensitivity to light (photophobia)
• Ear problems, such as pain, ringing in your ears, or feeling off balance
• Eye infections or drooping of your eyelid
• Women may stop having periods (amenorrhoea), but this may only be temporary
• Loss of fertility may happen with this drug so talk to your doctor before starting treatment if having a baby is important to you

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.