Dr Maese on the Use of Pediatric-Inspired Regimens in AYA and Adult ALL

“Adapting our new agents to pediatric-inspired protocols is something that's in the works, and I do think that there is an appetite out there to continue to investigate.”

Luke Maese, DO, an associate professor at the University of Utah School of Medicine; director of the Pediatric Leukemia/Lymphoma and Pediatric Cancer Genetics programs, director of the Clinical Trial Research Enterprise, and co-director of the Bone Marrow Failure program in the Division of Pediatric Hematology/Oncology at the University of Utah Primary Children’s Hospital; and a member of the Family Cancer Assessment Clinic at the University of Utah Huntsman Cancer Institute, discussed how the evolution of acute lymphoblastic leukemia (ALL) management may bring treatment protocols from the pediatric realm to adolescent and young adult (AYA) and adult patient populations. 

During the 1940s and 1950s, ALL began to garner significant attention within the scientific and medical communities, particularly as chemotherapy emerged as a novel therapeutic approach, Maese began. At that time, the primary focus was on pediatric patients, given that ALL predominantly affected children, he said. The historical emphasis on managing pediatric ALL led to the development of large, collaborative research networks—both nationally and internationally—forming a highly cooperative pediatric oncology community, he explained. These efforts prioritized ALL as a central area of study, given its status as the most common malignancy in children, he noted.

As a result of this early focus, pediatric-specific treatment protocols were established, Maese described. These protocols were tailored to a population with minimal baseline organ dysfunction and the ability to adhere closely to prescribed regimens, with parental oversight facilitating consistent treatment administration, according to Maese. Consequently, these pediatric regimens achieved remarkable success, and current cure rates for pediatric B-cell ALL now exceed 90%, he emphasized.

In contrast, AYA and adult patients historically received different therapeutic regimens compared with pediatric patients, Maese reported. Over time, there has been growing interest in evaluating whether pediatric-inspired treatment protocols could be effective and feasible in older populations, he stated. Since approximately the early 2000s, accumulating data have demonstrated that such regimens can offer clinical benefit in AYA and adult patients with ALL; however, applying these intensive regimens in older cohorts requires careful consideration of patient-specific factors, including age, comorbidities, and psychosocial readiness, he added. Treatment tolerability—both physical and psychological—must be evaluated, as adherence is essential to treatment success, and therapy discontinuation due to non-medical reasons must be avoided whenever possible, he explained.

Evidence continues to support the use of pediatric-inspired regimens in AYA patients, showing favorable outcomes, Maese emphasized. As new therapeutic agents emerge, integrating them into these established pediatric-style backbones remains an area of active investigation, he concluded.