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Case Report

A New Histology-Based Prognostic Index for Acute Lymphoblastic Leukemia: Preliminary Results of the “ALL Urayasu Classification”

by
Toru Mitsumori
1,
Hideaki Nitta
1,
Haruko Takizawa
1,
Hiroko Iizuka-Honma
1,
Chiho Furuya
1,2,
Suiki Maruo
1,2,
Maki Fujishiro
3,
Shigeki Tomita
4,
Akane Hashizume
5,
Tomohiro Sawada
6,
Kazunori Miyake
7,
Mitsuo Okubo
8,
Yasunobu Sekiguchi
9 and
Masaaki Noguchi
1,*
1
Department of Hematology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi 279-0021, Japan
2
Division of Hematology, Juntendo University Juntendo Hospital, Tokyo 113-0033, Japan
3
Institute for Environmental and Gender-Specific Medicine, Juntendo University Urayasu Hospital, Chiba 279-0021, Japan
4
Department of Diagnostic Pathology, Kasukabe Medical Center, Kasukabe 344-8588, Japan
5
Department of Diagnostic Pathology, Juntendo University Urayasu Hospital, Chiba 279-0021, Japan
6
Department of Clinical Laboratory, Juntendo University Urayasu Hospital, Chiba 279-0021, Japan
7
Department of Clinical Laboratory, Faculty of Medical Sciences, Juntendo University, Tokyo 113-8421, Japan
8
Laboratory of Blood Transfusion, Juntendo University Urayasu Hospital, Chiba 279-0021, Japan
9
Hematology Clinic, Saitama Cancer Center, Saitama 362-0806, Japan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(2), 768; https://doi.org/10.3390/jcm15020768 (registering DOI)
Submission received: 24 November 2025 / Revised: 7 January 2026 / Accepted: 12 January 2026 / Published: 17 January 2026
(This article belongs to the Special Issue Hematologic Malignancies: Treatment Strategies and Future Challenges: 2nd Edition)
Versions Notes

Abstract

Background/Objectives: Mechanisms underlying treatment resistance in hematopoietic malignancies such as acute lymphoblastic leukemia (ALL) include (1) enhanced activity of anticancer drug efflux mechanisms (MRP1); (2) suppressed activity of anticancer drug influx mechanisms (ENT-1); (3) enhanced drug detoxification activity (AKR1B10, AKR1C3, CYP3A4); (4) influence of the tumor microenvironment (GRP94), etc. We conducted this study to comprehensively and clinically examine treatment resistance due primarily to a decrease in the tumor intracellular anticancer drug concentrations. Methods: The subjects were 19 ALL patients who underwent initial induction therapy with alternating Hyper CVAD/MA therapy. Antibodies against 23 types of treatment resistance-associated proteins were used for immunohistochemical analysis of tumor specimens obtained from the patients, and correlations between the results of immunohistochemistry and the overall survival (OS) were retrospectively analyzed using the Kaplan–Meier method. Results: Based on the patterns of expression of the enzymes involved in treatment resistance, we classified the patients (Urayasu classification for ALL, which we believe would be very useful for accurately stratifying patients with ALL according to the predicted prognosis), as follows: Good prognosis group, n = 1, 5%: AKR1B1(+)/AKR1B10(−), 5-year overall survival (OS), 100%; Intermediate prognosis-1 group, n = 9, 5%: AKR1B1(−)/AKR1B10(−) plus MRP1(−), 5-year OS, 68%; Intermediate-2 prognosis group, n = 6.3%: AKR1B1(−)/AKR1B10(−) plus MRP1(+), median survival, 17 months, 5-year OS, 20%; and Poor prognosis group, n = 3, 16%: AKR1B1(−)/AKR1B10(+), median survival, 18 months, 5-year OS, 0%. n = 2. Conclusions: The Urayasu classification for ALL is considered reliable for predicting the prognosis of patients with ALL after the initial Hyper CVAD/MA remission induction therapy.
Keywords: ALL; Urayasu classification; prognostic index; MRP1; AKR1B10; AKR1B1 AR1C3; CYP3A4; MDR1; ENT1 ALL; Urayasu classification; prognostic index; MRP1; AKR1B10; AKR1B1 AR1C3; CYP3A4; MDR1; ENT1

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MDPI and ACS Style

Mitsumori, T.; Nitta, H.; Takizawa, H.; Iizuka-Honma, H.; Furuya, C.; Maruo, S.; Fujishiro, M.; Tomita, S.; Hashizume, A.; Sawada, T.; et al. A New Histology-Based Prognostic Index for Acute Lymphoblastic Leukemia: Preliminary Results of the “ALL Urayasu Classification”. J. Clin. Med. 2026, 15, 768. https://doi.org/10.3390/jcm15020768

AMA Style

Mitsumori T, Nitta H, Takizawa H, Iizuka-Honma H, Furuya C, Maruo S, Fujishiro M, Tomita S, Hashizume A, Sawada T, et al. A New Histology-Based Prognostic Index for Acute Lymphoblastic Leukemia: Preliminary Results of the “ALL Urayasu Classification”. Journal of Clinical Medicine. 2026; 15(2):768. https://doi.org/10.3390/jcm15020768

Chicago/Turabian Style

Mitsumori, Toru, Hideaki Nitta, Haruko Takizawa, Hiroko Iizuka-Honma, Chiho Furuya, Suiki Maruo, Maki Fujishiro, Shigeki Tomita, Akane Hashizume, Tomohiro Sawada, and et al. 2026. "A New Histology-Based Prognostic Index for Acute Lymphoblastic Leukemia: Preliminary Results of the “ALL Urayasu Classification”" Journal of Clinical Medicine 15, no. 2: 768. https://doi.org/10.3390/jcm15020768

APA Style

Mitsumori, T., Nitta, H., Takizawa, H., Iizuka-Honma, H., Furuya, C., Maruo, S., Fujishiro, M., Tomita, S., Hashizume, A., Sawada, T., Miyake, K., Okubo, M., Sekiguchi, Y., & Noguchi, M. (2026). A New Histology-Based Prognostic Index for Acute Lymphoblastic Leukemia: Preliminary Results of the “ALL Urayasu Classification”. Journal of Clinical Medicine, 15(2), 768. https://doi.org/10.3390/jcm15020768

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