AMBULATORY MANAGEMENT OF VARICELLA-ZOSTER VIRUS-INFECTION IN IMMUNOCOMPROMISED CANCER-PATIENTS

Immunocompromised patients with varicella-zoster virus (VZV) infection are at greater risk for dissemination and the development of complica tions than immunocompetent individuals. Consequently, they are general ly hospitalized in strict isolation rooms and treated with parenterall y administered acyclovir. Although effective, this approach is expensi ve and creates logistic difficulties in the hospital. We treated 38 im munosuppressed cancer patients presenting to our ambulatory treatment center with VZV infections with intravenous acyclovir (500 mg/m(2) 8-h ourly) in an ambulatory/home setting. Patients were monitored for succ ess or failure of therapy, progression of infection, development of co mplications or drug toxicity, and satisfaction/compliance with therapy . Most patients (33, or 87%) responded to therapy. Among the failures, 2 patients had progressive VZV infection, 2 were hospitalized due to renal toxicity, and 1 developed a superinfection, All patients eventua lly responded and there were no deaths on this study. Two patients rel apsed within 1 month of initial response. Both responded to retreatmen t with acyclovir, without hospitalization. The median duration of pare nteral therapy with acyclovir was 7.5 days. Seven patients (18%) had t o be switched to oral acyclovir (800 mg, 5 times a day) before complet e response, owing to problems with venous access. All 7 completed ther apy successfully. Overall, patients expressed a high level of satisfac tion with outpatient therapy, and there were no instances of noncompli ance or patient requests for withdrawal from study. The results of thi s study indicate that VZV infections in clinically stable immunosuppre ssed cancer patients are relatively benign and do not require hospital ization. Parenterally administered acyclovir in an ambulatory setting is effective therapy for such infections.