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

By Dylan Barrett,Amelia Campbell-Warner

Featured:

Wendy Stock

Mar 4, 2026

Learning objective: After reading this article, learners will be able to recall the rationale for the use of pediatric-inspired regimens in AYA patients with ALL.

Do you know... Which of the following best characterizes pediatric-inspired regimens used in adolescent and young adult patients, when compared with standard adult regimens?

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)?

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

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

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.

References

Neaga A, Jimbu L, Mesaros O, et al. Why do children with acute lymphoblastic leukemia fare better than adults? Cancers (Basel). 2021;13(15):3886. DOI: 10.3390/cancers13153886.
Janardan SK, Miller TP. Adolescents and young adults (AYAs) vs pediatric patients: survival, risks, and barriers to enrollment. Hematology Am Soc Hematol Educ Program. 2023;2023(1):581-586. DOI: 10.1182/hematology.2023000507.
Ram R, Wolach O, Vidal L, et al. Adolescents and young adults with acute lymphoblastic leukemia have a better outcome when treated with pediatric-inspired regimens: systematic review and meta-analysis. Am J Hematol. 2012;87(5):472-478. DOI: 10.1002/ajh.23149.
Zeckanovic A, Fuchs P, Heesen P, et al. Pediatric-inspired regimens in the treatment of acute lymphoblastic leukemia in adolescents and young adults: A systematic review. Curr Oncol. 2023;30(9):8612-8632. DOI: 10.3390/curroncol30090625.
Stock W, La M, Sanford B et al. What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children’s Cancer Group and Cancer and Leukemia Group B studies. Blood. 2008;112(5):1646-1654. DOI: 10.1182/blood-2008-01-130237.
Gupta S, Pole JD, Baxter NN, et al. The effect of adopting pediatric protocols in adolescents and young adults with acute lymphoblastic leukemia in pediatric vs adult centers: An IMPACT Cohort study. Cancer Med. 2019;8(5):2095-2103. DOI: 10.1002/cam4.2096.
Stock W, Luger SM, Advani AS, et al. A pediatric regimen for older adolescents and young adults with acute lymphoblastic leukemia: results of CALGB 10403. Blood. 2019;133(14):1548-1559. DOI: 10.1182/blood-2018-10-881961.
Sereda Y, Mai HJ, Kanaan G, et al. Pediatric-inspired regimens & HSCT for adolescents & young adults with acute lymphoblastic leukemia: Systematic reviews. Blood Adv. 2026. Online ahead of print. DOI: 10.1182/bloodadvances.2025018736.
DuVall AS, McNeer J, Cheung MC, et al. ASH 2026 guidelines for frontline management of acute lymphoblastic leukemia in adolescents and young adults. Blood Adv. 2026. Online ahead of print. DOI: 10.1182/bloodadvances.2021006469.

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Adolescent and young adult Calaspargase pegol Asparaginase erwinia chrysanthemi (recombinant)Pegylated asparaginase Asparaginase Pegaspargase Vincristine Eryaspase ALL by age Chemotherapy

This content is accurate as of the date of publication and is not updated retrospectively. Please refer to the latest available evidence, guidelines, and relevant regulatory information when making clinical decisions.