treosulfan: clinical use

Prescribing considerations

• Restrict initiation and supervision to clinicians experienced in conditioning followed by allogeneic transplantation.
• Assess active infection and cardiac, respiratory, hepatic and renal function before conditioning.
• Discuss infertility, fertility preservation, contraception and possible long-term risk of secondary malignancy.
• Use secure intravenous administration because treosulfan is an irritant.
• Consider age-specific neurological and respiratory risks in infants.

Contraindications and cautions

• Hypersensitivity to treosulfan
• Active uncontrolled infection
• Severe cardiac, pulmonary, hepatic or renal impairment
• Fanconi anaemia or another DNA-breakage repair disorder
• Pregnancy
• Live-vaccine administration

Monitoring

• Frequent full blood counts until haematopoietic recovery
• Surveillance for bacterial, viral and fungal infection
• Renal and hepatic function
• Mucositis, hydration and nutritional status
• Infusion site for extravasation
• Neurological and respiratory adverse effects in young infants

Clinical pharmacology

Treosulfan is a bifunctional alkylating prodrug that converts spontaneously to active epoxides. DNA alkylation and cross-link formation produce myeloablative, immunosuppressive and antineoplastic effects.

Formulation and product differences

• The selected product is a white crystalline powder for intravenous infusion and contains no excipients.
• It is reconstituted by trained personnel using sodium chloride 0.45% solution under cytotoxic-handling precautions.
• The reconstituted solution should not be refrigerated and must not be mixed with other medicines unless compatibility is established.

Solution for infusion

Route: Intravenous

Strengths: 1 g, 5 g