What is the rationale for the use of pediatric-inspired asparaginase-based regimens in AYA patients with ALL?

The ALL Hub was pleased to speak with Wendy Stock, the University of Chicago, US. We asked, What is the rationale for the use of pediatric-inspired asparaginase-based regimens in adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL)?

Stock reviews the clinical evidence and key considerations supporting this treatment approach in the AYA patient population.

Key points

• Typically, treatment regimens for adult patients with ALL have been less intensive in terms of use of steroids, vincristine, asparaginase, and intrathecal therapy compared with pediatric regimens, primarily due to concerns about treatment-related toxicities in adult patients.^1,2
• Historically AYA patients with ALL have had significantly worse outcomes than their younger counterparts.^3,4
• Several retrospective and non-randomized prospective studies have shown that the use of pediatric-inspired regimens in AYA patients, defined in the US as patients aged 15–39 years, is beneficial compared with historical controls.^5–8
• A number of multivariate analyses and systematic reviews have demonstrated the benefit of pediatric-based regimens over standard adult regimens in this patient population.^3,4
• A recent systematic review and meta-analysis, sponsored by the American Society of Hematology, provides further evidence supporting the use of pediatric-inspired regimens in young adult patients with ALL.⁸
• This analysis was conducted to support the development of clinical practice guidelines on treatment of AYA patients with ALL, which have now been published in Blood Advances.⁹

This educational resource is independently supported by Jazz Pharmaceuticals. All content was developed by SES in collaboration with an expert steering committee. Funders were allowed no influence on the content of this resource.