Pentostatin


Pentostatin (2'-deoxycoformycin) is an antibiotic produced by culture broths of Streptomyces antibioticus, and widely used as antineoplastic agent (lymphoid malignancies, mycosis fungoids, chronic lymphocytic leukemia).
 
Incidence
0.5 to 1 %.
 
Risk factors
Concomitant use of allopurinol.
 
Clinical manifestations
General: anaphylactic shock, fever.
 
Cutaneous: pruritus, rash, flushing, edema, dryness of the chest and limbs.
 
Respiratory: cough, pulmonary infiltrates.
 
Hematological: eosinophilia.
 
Diagnostic methods
Hypersensitivity vasculitis involving arteries and veins in the heart, spleen, cerebral cortex (autopsy).
 
Recurrence of reactions with drug re-challenge.
 
Mechanisms
Concomitant administration of allopurinol to prevent hyperuricemia secondary to tumor lysis could enhance pentostatin toxicity.
 
Pentostatin is formulated using mannitol and sodium hydroxide.
 
Management
Avoidance of systematic use of allopurinol.

References

  1. O’Dwyer P.J, King S.A, Eisenhauer E, Grem J.L, Hoth D.F, "Hypersensitivity reactions to deoxycoformycin", Cancer. Chemother. Pharmacol., 1989; 23 (3): 173-5
  2. Steinmetz J.C, DeConti R, Ginsburg R, " Hypersensitivity vasculitis associated with 2-deoxycoformycin and allopurinol therapy", Am. J. Med., 1989; 86 (4): 498-9

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.