Pentostatin therapy of T-cell lymphomas with cutaneous manifestations

Purpose: To determine the side effects of and response to pentostatin in patients with T-cell lymphomas with cutaneous manifestations. Patients and Methods: Pentostatin was administered to 28 patients who had relapsed cutaneous T-cell lymphoma or peripheral T-cell lymphoma with prominent cutaneous disease. The starting dose was between 3.75 to 5.0 mg/m²/d intravenous for 3 days every 3 weeks. Results: Of the 24 patients assessable for response, 17 (71%) achieved a partial remission (46%) or complete remission (25%). The patients had a median number of three (range, one to 12) prior therapies. Of the 86 courses of pentostatin given, 39 were administered at doses of 5.0 mg/m²/d and 30 at doses of 3.75 mg/m²/d. Dose escalation to 6.25 mg/m²/d was possible in only five courses, and toxicity necessitated dose reduction to 2.8 mg/m²/d in 12 courses. The most common side effects were granulocytopenia, nausea, and non-neutropenic fever. Most patients developed significant lowering of CD4 counts. Herpes zoster was seen within 1 year after pentostatin in five patients (19%). Conclusion: Pentostatin is an active agent in heavily pretreated T-cell lymphomas with cutaneous manifestations.