A highly pH- and temperature-sensitive nonenzymatic conversion to the active monoepoxide, glomerular filtration, and tubular reabsorption are involved in the elimination of the prodrug treosulfan.

To date, blood pH, body temperature, and volume of intravenous infusions administered to HSCT patients have been neglected as the covariates of treosulfan clearance, but are worth testing.

The pharmacokinetics of the active epoxides of treosulfan are necessary to understand clinical observations in conditioning prior to HSCT.