Thiotepa (Specialist drug)

How it works

It is a polyfunctional alkylating agent that cross-links DNA, disrupting replication and causing cytotoxicity in dividing cells.

Prescribing in practice

• It causes profound myelosuppression, which is the intended effect in transplant conditioning but mandates intensive haematological support and infection precautions.
• It is excreted in part through the skin and can cause skin reactions; frequent washing and dressing changes are advised to reduce local toxicity during high-dose use.
• It is mutagenic, carcinogenic and teratogenic; effective contraception is required and handling must follow cytotoxic precautions.

Monitoring

Monitor full blood count closely along with liver, renal and mucosal status during and after administration.

Counselling the patient

• Wash and change clothing and bedding frequently during treatment as advised to protect your skin.
• Report fever, bleeding, bruising or mouth soreness promptly.
• Use reliable contraception and discuss fertility preservation before treatment.

Evidence & guidelines

Use is guided by the manufacturer's SPC and established transplant conditioning protocols.