Age cutoff in lymphoma diagnosis

decreased immune response and dysregulated coordination between inflammatory and inflammation-neutralizing processes. The decline in immune competence is invariably seen with aging. As a consequence, viral or bacterial infections, chronic inflammatory disorders, autoimmune diseases, and cancers are more prevalent in elderly. In addition to genomic and epigenomic instability with age, decreased immunosurveillance plays an importance role in tumorigenesis. In a young individual, there are strong supplies of cytokines including insulin-like growth factor-1, keratinocyte growth factor and interleukin-7 that induce production of naïve T-cells with a diverse T-cell receptor repertoire. When antigen is presented by antigen-presenting cells, effector T-cells and memory T-cells are quickly produced. In an aged person, there is a significant decline in the stimulatory cytokines, hence leading to a decreased T-cell population. Often, chronically stimulated effector T-cells and memory T-cells with limited repertoire diversity predominate and progressive expansion of oligoclonal T-cells, particularly CD8 + , CD27-, CD28-, CD45RA + and CD57 + T-cells are seen [1]. Analysis of immuno-globulin heavy variable gene (IGHV) complementarity determining region (CDR) 3 using blood mononuclear cells showed that B-cell receptor repertories dramatically decline with age in parallel with clonal expansion of B-cells in vivo. Imbalance between inflammatory and inflammation-neutralizing processes prompts a low-grade inflammatory process. Chronic inflammation induces radical oxygen species (ROS) that can cause dysregulation of critical signaling pathways such as p53, retinoblastoma (Rb), nuclear factor (NF)-κB, and mitogen activated protein kinases (MAPKs). Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphoma and encompasses a heterogeneous group of tumors with several variants, subgroups, subtypes and entities. Gene expression profiling has identified three distinct groups of DLBCL – germinal center B-cell-like (GCB), activated B-cell-like (ABC), and mediastinal large B-cell lymphoma (MLBCL). Elderly patients commonly have ABC subtype of DLBCL with frequent BCL2 expression and genetic complexity. Chromosomal gains in 1q21, 18q21, 7p22, 7q21 and 3q27 are more often seen with Editorial age, but IRF4 break is less frequent in elderly. Epidemiological data shows that there is a significant increase of DLBCL incidence with age. The epidemiological association with DLBCL and aging is partially explained by data from Jaiswal and colleagues [2]. Analysis of whole-exome sequencing data from DNA in the peripheral blood cells of 17,182 persons without hematologic malignancies showed that prevalence of somatic mutations increase with age and the cumulative incidence of hematologic cancer is quantitatively associated with presence of somatic mutations [2]. Epigenetic alterations are also associated with …