access to quality care for children with leukemia before the COVID-19 pandemic was already disadvantaged, with 5-year survival rates of 40%-60% compared to 90%-95% in developed countries. 1,2 Thus, safeguarding care of acute lymphoblastic leukemia (ALL) patients during the COVID-19 pandemic has represented a challenge.We analyzed 553 visits from 89 patients with ALL in "Hospital Universitario Dr. José Eleuterio Gonzalez." We conventionally administer all chemotherapy in an outpatient backbone. Some of the strategies implemented were increasing the capacity of infusion beds, offering telemedicine follow-up 24/7, continuing with the transplant program with outpatient intent, providing social support, and partnering with non-governmental organizations to assist families in paying for chemotherapy when needed. In our center, we did not modify or reduced intensity of the chemotherapy regimen. In addition, SARS-Cov-2-positive patients in induction received Capizzi chemotherapy regimen.Chemotherapy administration was timely and performed as per the protocol in 83% (n = 459) of the records reviewed. However, adherence was lower during the consolidation and intermediate maintenance phases (60.9% and 64%) and was associated with a shortage of cytarabine and methotrexate.The main causes of treatment delays were lack of financial resources (2.45), lack of inpatient beds (1.8%), and chemotherapy stock-outs (1.3%). In addition, the treatment abandonment rate was 3.3%.Other centers in low-and middle-income countries have reported their challenges during the pandemic, including missed or delayed diagnosis, chemotherapy shortages, shortfall of blood products, 3 and closure of HSCT programs. 2,4 Also, Gratz et al. reported decreased financial support, reduced clinical staff, and decreased available beds.The lack of availability of inpatient beds in our center was overcome by providing an ambulatory treatment regimen. If the treatment delay was >5 days, the 6-h outpatient infusion of methotrexate was implemented for low and intermediate risk. 5 During this time, 22 patients (24.7%) had a positive PCR test for SARS-CoV2; the median age was 5 years (range, 0.9-15). Two patients (9%) were diagnosed with COVID-19 and ALL simultaneously, eight patients (36%) during intensive phases of treatment, and ten (45%) with extended maintenance. In addition, two patients were diagnosed after haploidentical HSCT.The incidence of COVID-19 in our series was 24.7%, while other LA centers reported 13.1% and 58%. 6,7 Our mortality rate was 4.5%, similar to the global registry of Covid reported 8 ; however, another group in LA reported up to 37%. 6 Critical or severe illness was classified in 18%.Seven patients (32%) developed pneumonia, and two (9%) had multisystem inflammatory syndrome. Five (22.7%) required oxygen support, and two (9%) required mechanical ventilation. Three patients (13.6%) currently have late sequelae.The additional support interventions in our center allowed the continuity of ALL treatment for >80%. However, our high rate of abando...

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