Role of late-onset smoking in super-aged patients with diffuse large B-cell lymphoma: a real-world study in China between 2010 and 2024

Aim To investigate the prognostic impact of early-onset smoking history (started smoking before 24 years old) on the survival of Chinese patients aged ≥ 80 years with diffuse large B-cell lymphoma (DLBCL). Methods Patients aged ≥ 80 years DLBCL with smoke history admitted to our center from 2010 to 2024 were retrospectively enrolled. Patients who started smoking before 24 years old were defined as early-onset smoking group, while who started smoking after the age of < 24 years old were defined as late-onset smoking group. The overall survival (OS), progression-free survival (PFS) and treatment-related complications were compared between the two groups. Cox regression model was used to analyze the prognostic factors. Results After follow-up duration of 28.7 months, 68 patients were included. The median OS of early-onset smoking group ( n = 29) was 2.3 years, which was significantly lower than that of late-onset smoking group ( n = 39, 3.7 years, p < 0.01). Multivariate analysis illuminated that late-onset smoking decreased the risk of death significantly (HR = 0.317, p = 0.031), as well as another risk factor: ECOG < 2 (HR = 0.569, p = 0.042). Conclusions Remarkably, late-onset smoking and better performance status portended a favorable prognosis of super-aged patients with lymphoma.