Varicella-Zoster Infection in Patients with Cancer

Abstract

Over a 24-month period, among 419 patients with cancer, zoster occurred in 25% of patients with Hodgkin's disease, 8.7% of other lymphoma patients, but in only 1.2% of patients with acute leukemia and 1.8% of patients with solid tumors. A disseminated or generalized form of zoster occurred in 12 of the 37 patients with zoster; these patients were more frequently DNCB-negative, but they were not necessarily receiving continuing cancer chemotherapy. Localization of zoster was frequently related to a site of prior radiation therapy. Recurrence of zoster occurred in 8 patients. Patients with advanced Hodgkin's disease, cutaneous anergy, and recent nodal radiotherapy were inordinately predisposed to zoster. Absent varicella-zoster complement fixation titers in exposed patients with lymphoma but not leukemia also predisposed to zoster development. Zoster was an exogenously acquired reinfection in many patients, with a prolonged incubation period. No exposed staff member developed clinical infection, and only two had an antibody rise.