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Adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) are a growing population with unfavorable outcomes relative to pediatric peers. Historic underrepresentation in prospective studies has complicated unifying recommendations surrounding optimal therapeutic strategy for this group. Retrospective studies highlighting the superiority of pediatric-inspired regimens in this context have given rise to small prospective trials supporting these findings. Data demonstrating concordant implementation of these protocols outside of clinical trials is lacking. We designed a retrospective study summarizing therapeutic strategies for over 200 AYAs with ALL treated within an integrated healthcare system. We found increasing usage of pediatric protocols over the study period associated with higher utilization of outpatient clinic appointments, lower number of inpatient days, equivalent toxicity profiles, and favorable mortality rates. Our findings highlight the wide implementation and superiority of pediatric regimens for AYAs undergoing treatment for ALL in the community setting, for which more data have been needed.