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Grafapex

treosulfan
Alkylating AgentFDA Approved 2025medac GmbH
Route
IV
Half-Life
~1 hr
FDA Approved
2025
Manufacturer
medac GmbH
1. Indications and Usage

With fludarabine as conditioning prior to allo-HSCT in adults and pediatric patients 1+ years with AML or MDS.

2. Dosage and Administration

10 g/m2 IV on Days -4, -3, -2 prior to transplant (with fludarabine 30 mg/m2 on Days -6 to -2).

3. Dosage Forms and Strengths

Injection: 5 g lyophilized powder in single-dose vial

4. Contraindications

None listed in the prescribing information.

5. Warnings and Precautions
  • Myelosuppression: Severe and prolonged cytopenias expected.
  • Infections: Serious and fatal infections reported.
  • GVHD: Both acute and chronic reported.
  • Hepatotoxicity: Including SOS/VOD.
  • Embryo-Fetal Toxicity: Can cause fetal harm.
6. Adverse Reactions
Most Common Adverse Reactions

Mucositis (65%), Nausea (55%), Febrile Neutropenia (48%), Diarrhea (42%), Vomiting (40%), Infections (38%), Pyrexia (36%), Rash (28%)

Mucositis
65%
Nausea
55%
Febrile Neutropenia
48%
Diarrhea
42%
Vomiting
40%
Infections
38%
Pyrexia
36%
Rash
28%

Consult the complete prescribing information for a comprehensive list of adverse reactions and their frequencies.

7. Drug Interactions

Live Vaccines: Avoid until immune reconstitution.

8. Use in Specific Populations
Pregnancy

Consult the full prescribing information for pregnancy-related considerations.

Lactation

Refer to prescribing information for lactation guidance.

Pediatric Use

Pediatric safety and efficacy information is detailed in the full label.

Hepatic/Renal Impairment

Dose modifications for organ impairment are specified in the complete prescribing information.

12. Clinical Pharmacology
Mechanism of Action

Treosulfan is a prodrug alkylating agent that forms reactive epoxide intermediates at physiological pH, cross-linking DNA. It provides reduced-intensity conditioning with potentially lower toxicity than busulfan.

Pharmacokinetics

Half-life: ~1.5 hours. Elimination primarily renal (25-30% unchanged).

14. Clinical Studies

Clinical efficacy and safety data supporting the approval are available in the full prescribing information and from the clinical trials listed below.

Pivotal Clinical Trials
Additional Resources
FDA-Approved Tumor Types

Grafapex has FDA-approved indications across the following cancer types covered on CancerDrugEvidence:

External Resources
Important Notice: This page is intended as a navigational reference to the FDA-approved prescribing information for Grafapex. It does not replace the full prescribing information. Healthcare professionals should consult the complete package insert available at DailyMed before making prescribing decisions. Patient-specific factors should always guide clinical decision-making.

Frequently Asked Questions

What is Grafapex (treosulfan) approved for?

Grafapex (treosulfan) is an FDA-approved oncology agent. Refer to the full prescribing information for complete indication details.

How is Grafapex (treosulfan) administered?

Refer to the full prescribing information for dosing schedules, administration instructions, and dose modifications.

How does Grafapex (treosulfan) work?

Treosulfan is a prodrug alkylating agent that forms reactive epoxide intermediates at physiological pH, cross-linking DNA. It provides reduced-intensity conditioning with potentially lower toxicity than busulfan.

What are the most common side effects?

Mucositis (65%), Nausea (55%), Febrile Neutropenia (48%), Diarrhea (42%), Vomiting (40%), Infections (38%), Pyrexia (36%), Rash (28%) Mucositis 65% Nausea 55% Febrile Neutropenia 48% Diarrhea 42% Vomiting 40% Infections 38% Pyrexia 36% Rash 28%