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Background There is limited data on outcomes in cancer patients with coronavirus disease 2019 (COVID‐19) from lower middle‐income countries (LMICs). Patients and Methods This was an observational study, conducted between 12 April and 10 June 2020 at Tata Memorial centre, Mumbai, in cancer patients undergoing systemic therapy with laboratory confirmed COVID‐19. The objectives were to evaluate cumulative 30‐day all‐cause mortality, COVID‐19 attributable mortality, factors predicting mortality, and time to viral negativity after initial diagnosis. Results Of the 24 660 footfalls and 7043 patients evaluated, 230 patients on active systemic therapy with a median age of 42 (1‐75) years were included. COVID‐19 infection severity, as per WHO criteria, was mild, moderate, and severe in 195 (85%), 11 (5%), and 24 (11%) patients, respectively. Twenty‐three patients (10%) expired during follow‐up, with COVID‐19 attributable mortality seen in 15 patients (6.5%). There were no mortalities in the pediatric cohort of 31 (14%) patients. Advanced stage cancer being treated with palliative intent vs others [30‐day mortality 24%% vs 5%, odds ratio (OR) 5.6, 95% CI 2.28‐13.78, P, COVID‐19 attributable mortality in cancer patients on systemic therapy in LMICs appears lower than published data and slightly more than an unselected patient's cohort. Delayed recovery in terms of SARS COV‐2 negativity is seen in these patients. Treating Cancer remains the priority.

Introduction Diffuse large B-cell lymphoma (DLBCL) commonly affects the elderly population and the treatment is often challenging because of the close interplay between age, comorbidities, frailty as well as cognitive and psychosocial factors. Anthracycline constitutes the cornerstone of the treatment regimen of Non-Hodgkin lymphoma but is associated with several side-effects including cardiotoxicity. At our institute, we replace doxorubicin with etoposide in cases where compromised cardiac function, performance status (PS) and multiple comorbidities are major concerns. We aim to retrospectively analyze the treatment outcomes of patients with DLBCL aged ≥ 60 years and specifically compare R-CHOP and R-CEOP regimens. Methods In this retrospective study, we included patients aged ≥ 60 years, newly diagnosed with DLBCL according to WHO classification between January 2015 to December 2018 at our center. Chemotherapy regimens received included R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone), R-CE (Etoposide) OP for anthracycline-ineligible or elderly frail patients and R-EPOCH, followed by radiotherapy for residual disease or bulky sites (size > 7cm). The decision to use anthracycline or non-anthracycline based regimen was at the discretion of the physician depending on the performance status, frailty and serum albumin levels. Dose of etoposide used in the R-CEOP regimen was 65mg/m 2 orally on day 1-3. Primary G-CSF prophylaxis was used in all patients. After 4 cycles of chemotherapy, patients underwent an interim PET-CT for response evaluation. Patients who attained partial response underwent a repeat PET-CT evaluation at the end of 6 cycles. Post treatment completion, patients were followed up for clinical examination every three months for the first two years, six monthly for the next three years and annually thereafter. Results A total of 218 patients were included. The median age of patients was 65 years (range, 60-88 years). Patients were divided into two age-groups with 124 patients (56.9%) of the age group of 60-65 years and 94 patients (43.1%) were aged above 65 years. Of the 218 patients, 71 patients (32.6%) received R-CHOP regimen and 137 patients (62.4%) received R-CEOP regimen, while 10 patients (5.0%) received R-EPOCH. More patients aged >65 years received R-CEOP than in the 60-65 years age group (83% vs 47.6%) and the difference was statistically significant (p-value 2 (3.6%), and physician's discretion in 48.9% of cases. Baseline disease characteristics including NCCN-IPI of patients treated with both these regimens were comparable. Complete response rate and overall response rate were higher in the R-CHOP group compared to the R-CEOP group, but statistically significant difference was found only among 60-65 years of age group. Among patients aged 60-65 years, the incidence of febrile neutropenia and grade III/IV hematological toxicities were significantly higher in the R-CHOP group than in the R-CEOP group. The overall median follow-up was 22.71 months (Range 1-81 months). The 2-year progression-free survival (PFS) rate in the R-CHOP group was higher than that in the R-CEOP group (79.1% vs 49.6%, p-value Conclusion Age and comorbidities are not absolute contraindications to the use of anthracyclines. Fit patients without cardiac contraindications should receive R-CHOP regimen whenever possible. Geriatric assessment tools should be used for the frail or unfit patients to guide appropriate therapy and further prospective trials should be done in this direction. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.