Treosulfan crystalline powder

Treosulfan is the medication given to people before a bone marrow transplant from a donor known as allogeneic hematopoietic stem cell transplantation. Trecondi is the trade name of Treosulfan. It is given in combination with another drug called fludarabine. It comes in the form of crystalline powder for solution for infusion of 5 gm strength.

Usage of Treosulfan 5 gm

Treosulfan is used before allogeneic hematopoietic stem cell transplantation (alloHSCT). It is used as a 'conditioning' treatment to clear the bone marrow and make space for the transplanted bone marrow cells that can produce healthy blood cells. Healthcare professionals recommend it to adults, children, and old people with severe disorders having allogeneic hematopoietic stem cell transplantation. 

Administration and Dosage of Treosulfan 5 g

1. Patients with malignant disease

Treosulfan is given in combination with fludarabine.

The recommended doses and schedule of administration are:

Treosulfan 10 g body surface area (BSA) per day as a two-hour intravenous infusion, given three consecutive days before stem cell infusion. The total treosulfan dose is 30 g.

Administer Fludarabine 30 mg BSA per day for half an hour for intravenous infusion, given five consecutive days before stem cell infusion. The total fludarabine dose is 150 mg. Administer Treosulfan before fludarabine on three consecutive days. 

2. Patients having non-malignant disease. 

Treosulfan can be given in combination with fludarabine with or without Thiotepa Injection. 

The recommended doses and schedule of administration are:

Treosulfan 14 g body surface area (BSA) per day as a two-hour intravenous infusion, given three consecutive days before stem cell infusion. The total treosulfan dose is 42 g.

Fludarabine 30 mg BSA per day as a half an hour intravenous infusion, given five consecutive days before stem cell infusion. The total fludarabine dose is 150 mg

Treosulfan should be administered before fludarabine.

Thiotepa 5 mg twice a day, given as two intravenous infusions over 2–4 hours on the second day before stem cell infusion. 

3. Elderly population

There is no requirement for the dose adjustment in any subset for elderly patients. 

4. Renal and hepatic impairment 

No dose adjustment is required for mild or moderate impairment, but Treosulfan is contraindicated in patients with severe disorders. 

5. Pediatric population

Treosulfan 5 g injection is given in combination with fludarabine with or without thiotepa.

The recommended doses and schedule of administration are:

Treosulfan 10-14 g body surface area per day as a two-hour intravenous infusion, given three consecutive days before stem cell infusion. The total treosulfan dose is 30-42 g. The dose of Treosulfan is administered according to the body surface area of the patient.

Fludarabine 30 mg BSA per day as a half an hour intravenous infusion, given five consecutive days before stem cell infusion. The total fludarabine dose is 150 mg.

• Administer Treosulfan before the dosage of fludarabine.
• Thiotepa (intensified regimen 5 mg twice a day), given as two intravenous infusions over 2– 4 hours on the second day before stem cell infusion.

The safety and efficacy of Treosulfan medicine in children less than 1 month of age have not yet been established.

Precautions before administration

• The shelf-life of an unopened vial of Treosulfan is 5 years.
• Treosulfan is for intravenous infusion for two-hour.
• When handling Treosulfan, one should avoid inhalation, skin contact, or contact with mucous membranes. Keep pregnant women away from cytotoxics.
• Administration of the medicine should be performed using a safe technique to avoid extravasation. 

Side effects 

Treosulfan injection has common side effects such as infections, nausea, stomatitis (inflammation of the lining of the mouth), vomiting, diarrhea, and abdominal pain. Cardiac disorders, gastrointestinal disorders, nervous system disorders, blood and lymphatic system disorders, and many more are severe side effects of the medicine.

Overdose

There is no antidote for overdose of Treosulfan. One should take medicine according to the recommended dosage of the doctor. The principal toxic effect of Treosulfan is profound myeloablation and pancytopenia. Moreover, acidosis, skin toxicity, nausea, vomiting, and gastritis might occur. Healthcare professionals should monitor the patient regularly for worsening symptoms or any such symptoms. 

Cost of Treosulfan

It is seen that the price of medicine made by innovators is more costly than the other suppliers. In India, Treosulfan cost is reasonable the reason is multiple generic brands are available in India. The drug is easily available with the suppliers like Ikris Pharma Network- Pharmaceutical wholesale distributors in India, a trusted brand for delivering such medications in India and abroad at the best possible time.