Infections in patients with Hodgkin's disease: a clinical study of 300 consecutive adult patients.

Patterns of infection were investigated in 300 consecutive adult patients with Hodgkin's disease who were followed for an average of 5.7 years after diagnosis. Serious infection other than cutaneous herpes zoster infection developed in 21% of the 300 patients. Sixty percent of the episodes of serious infection were microbiologically documented (MDSI). Bacteremia was the most frequent MDSI, and Streptococcus pneumoniae was the most common organism causing MDSI. Bacteremia due to S. pneumoniae occurred in 3% of the 300 patients, was rarely fatal, and almost always was associated with prior relapse of Hodgkin's disease and with prior extensive combined modality therapy. The incidence of bacteremia due to S. pneumoniae among patients who had received extensive radiation therapy plus chemotherapy was 5.5%. Identifiable factors predisposing patients to infection were present at the time of all but two of the 68 episodes of MDSI that were observed. Patients who had received extensive radiotherapy plus chemotherapy had a higher incidence of subsequent episodes of serious infection and MDSI than did those who had received extensive radiotherapy alone. Among patients without Hodgkin's disease at autopsy but with infection contributing to death, only four patients lacked other major compromising illnesses. Patients cured of Hodgkin's disease who remained free of major second illnesses or long-term complications of prior treatment rarely developed MDSI other than infections caused by the post-splenectomy spectrum of organisms, regardless of the extent of prior cumulative immunosuppressive therapy.