treosulfan

Treosulfan, sold under the brand name Trecondi among others, is an alkylating medication given to people before they have a bone marrow transplant from a donor known as allogeneic hematopoietic stem cell transplantation. It is used as a 'conditioning' treatment to clear the bone marrow and make room for the transplanted bone marrow cells, which can then produce healthy blood cells. It is used together with another medicine called fludarabine in adults and children from one month of age with blood cancers as well as in adults with other severe disorders requiring a bone marrow transplant. It belongs to the family of drugs called alkylating agents. In the body, treosulfan is converted into other compounds called epoxides which kill cells, especially cells that develop rapidly such as bone marrow cells, by attaching to their DNA while they are dividing. DNA cross-linking is considered a primary mechanism underlying the pharmacological action of treosulfan, and epoxides formed from treosulfan may cross-link DNA via at least two chemical pathways.

Preclinical studies in animal models have shown that treosulfan is widely distributed to the liver, lungs, bone marrow, and skeletal muscle, with tissue-to-plasma ratios of 0.96, 0.82, 0.82, and 0.77, respectively. Lower biodistribution was observed in the brain and the aqueous humor of the eye (both 0.10). In juvenile rats with an immature blood–brain barrier, brain exposure was higher (0.15) than in young adult rats. The monoepoxide of treosulfan (EBDM) exhibited greater brain penetration than the parent compound, with tissue-to-plasma ratios of 0.25 in young adult rats and 0.50 in juvenile rats.