Herpes zoster-varicella infection in malignant lymphomas. influence of splenectomy and intensive treatment

The medical records of 407 consecutive patients with malignant lymphoma (Hodgkin's disease 184, non-Hodgkin's lymphomas 223) admitted to the Istituto Nazionale Tumori of Milan from August 1970 to April 1973 were analyzed for the occurrence of varicella-zoster (V-Z). Two hundred and thirty-two patients underwent laparotomy with splenectomy as part of their diagnostic work up. This procedure was not carried out in 175 either because of extralymphatic involvement before surgery or because they were high risk patients. V-Z occurred in a total of 17% of patients with Hodgkin's disease and in 9% of those with non-Hodgkin's lymphomas, respectively. In Hodgkin's disease the infection was more often encountered in the lymphocytic depletion type (26%), while no statistical difference was observed among lymphocytic, histiocytic and mixed type lymphomas. The incidence of infection during the first 12 months from staging was 58% for Hodgkin's disease and 71% for non-Hodgkin's lymphomas. The incidence of V-Z was higher (16%) in splenectomized compared to non-splenectomized (9%) patients. The difference was statistically significant (P <0·05). The incidence of zoster was found to be particularly high in splenectomized patients both with Hodgkin's (27%) and non-Hodgkin's (15%) lymphomas treated with cyclic combination chemotherapy.