Pentostatin Cyclophosphamide

CYCLOPHOSPHAMIDE PENTOSTATIN t risk of potentially fatal cardiac toxicity Attributed to interference of adenosine metabolism by cyclophosphamide Avoid co-administration... 

Clinically important, potentially hazardous interactions with altretamine, amikacin, aminoglycosides, antineoplastics, bleomycin, busulfan, carboplatin, carmustine, chlorambucil, cisplatin, corticosteroids, cyclophosphamide, cytarabine, dacarbazine, dactinomycin, daunorubicin, docetaxel, doxorubicin, estramustine, etoposide, fludarabine, fluorouracil, gemcitabine, gentamicin, hydroxyurea, idarubicin, ifosfamide, indomethacin, kanamycin, levamisole, lomustine, mechlorethamine, melphalan, mercaptopurine, methotrexate, mitomycin, mitotane, mitoxantrone, neomycin, pentostatin, plicamycin, procarbazine, streptomycin, streptozocin, thioguanine, thiotepa, tobramycin, tretinoin, uracil, vinblastine, vincristine, vinorelbine... 

Weiss MA, Maslak PG, Jurcic JG, et al. Pentostatin and cyclophosphamide An effective new regimen in previously treated patients with chronic lymphocytic leukemia. J Qin Oncol 2003 21 1278-1284. 

Acute and fatal cardiovascular collapse developed in two patients when pentostatin was added to h h-dose cyclophosphamide treatment Some recent studies have found the combination to be effective and safe in patients with chronic lymphocytic leukaemia. 

A clinical study that was started to find out if pentostatin would improve the immunosuppressive effects of cyclophosphamide, carmustine and etoposide in bone marrow transplant patients was stopped when acute and fatal cardiovascular collapse developed in the first 2 patients. Both patients had been given cyclophosphamide 800mg/m and etoposide 200 mg/m, both every 12 hours for 8 doses, and carmustine 112 mg/m daily for 4 doses. On day 3 pentostatin 4 mg/m, given over 4 hours, was added. Within 8 to 18 hours after completion of chemotherapy both patients developed confusion, hypothermia, hypotension, respiratory distress, pulmonary oedema, and eventually fatal ventricular fibrillation within 45 to 120 minutes of the first symptoms. A later study in rats similarly found that pentostatin markedly increased the acute toxicity of cyclophosphamide. The reasons for this cardiotoxicity are not understood. Neither of the 2 patients had previously shown any evidence of cardiac abnormalities. ... 

However, in a more recent study in patients with previously treated chronic lymphocytic leukaemia (CLL), pentostatin 4 mg/m with cyclophosphamide 600 mg/m was found to be safe and effective. Another study found that pentostatin 4 mg/m and cyclophosphamide 600 mg/m with or without rituximab 375 mg/m was safe and effective for patients with Waldenstrom s macroglobinaemia. Other studies in patients with previously treated or untreated CLL found that cyclophosphamide 600 mg/m with pentostatin 4 or 2 mg/m and rituximab 375 m m was effective and was either well-tolerated or had only modest toxicity. ... 

Hensel M, Villalobos M, Komacker M, Krasniqi F, Ho AD. Pentostatin/cyclophosphamide with or without rituximab an effective regimen for patients with Waldenstrom s macroglob-ulinaemia/lymphoplasmacytic lymphoma. Clin Lymphoma Myeloma (2005) 6,131-5. 

Lamanna N, Kalaycio M, Maslak P, Jurcic JG, Heaney M, Brentjens R, Zelenetz AD, Horgan D, Gencarelli A, Panageas KS, Scheinberg DA, Weiss MA. Pentostatin, cyclophosphamide, and rituximab is an active, well-tolerated regimen for patients with previously treated chronic lymphocytic leukaemia. JC/m Oncol (2006) 24, 1575-81. 

Kay ME, Geyer SM, Call TG, Shanafelt TD, Zent CS, Jelinek DF, Tschumper R, Bone ND, Dewald GW, Lin TS, HeeremaNA, SmithL, Grever MR, Byrd JC. Combination chemoimmu-notherapy with pentostatin, cyclophosphamide, and rituximab shows significant clinical activity with low accompanying toxicity in previously untreated B chronic lymphocytic leukaemia. Blood 2007, 109, 405-11. 

In patients given nephrotoxic chemotherapy, such as cisplatin cyclophosphamide, ifosfamide, methotrexate, bleomycin, streptozotocin, pentostatin, or other nephrotoxic drugs, and in patients in whom extensive tumor lysis with hyperuricemia, hypercal-... 

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