Pentostatin (Nipent) and high-dose cyclophosphamide for the treatment of refractory autoimmune disorders

Autoimmune rheumatologic disease has a wide range of clinical expression that occasionally can be disabling. Patients with visceral organ involvement are exposed to significant morbidity and mortality if effective therapy is not forthcoming. The mainstay of therapy has been immunosuppression. However, some patients fail to respond to conventional doses of corticosteroids, methotrexate, or cyclophosphamide, and new approaches are needed for these patients. One new approach involves the use of intensified immunosuppression by combining cyclophosphamide with purine nucleoside analogs, including the adenosine deaminase inhibitor pentostatin (Nipent; SuperGen, San Ramon, CA).