ORIGINAL ARTICLE
Physician perceptions and preferences in the treatment
of acquired immunodeficiency syndrome (AIDS)-related
lymphoma
Matthew C. Cheung
&
Kevin R. Imrie
&
Heather A. Leitch
&
Laura Y. Park-Wyllie
&
Rena Buckstein
&
Tony Antoniou
&
Mona R. Loutfy
Received: 8 February 2007 / Accepted: 5 March 2007 /Published online: 20 March 2007
#
Springer-Verlag 2007
Abstract The optimal management of acquired immuno-
deficiency syndrome-related lymphoma (ARL) in the era of
combination antiretroviral therapy (cART) is unclear. We
administered a survey to determine physician preferences
and perceptions in the management of ARL and to assess
the variability in treatment in Canada. Of 196 lymphoma-
treating physicians, 117 (63%) responded. The majority of
respondents (98%) had a positive attitude towards the
treatment of ARL. Most physicians (66%) recommended
the concomitant use of cART in the care of their patients
with ARL, and a majority (86%) recommended CHOP-like
regimens (cyclophosphamide, doxorubicin, vincristine, and
prednisone) to form the backbone of chemotherapy. The
addition of rituximab was preferred by 43% of physicians,
while 39% and 18% would either not use rituximab or were
unsure of the agent’s role, respectively. In logistic regres-
sion analysis, use of rituximab was predicted only by
location of practice (province); physicians from the prov-
ince of British Colombia were much more likely to
administer rituximab than practitioners from Ontario (odds
ratio 41.8; 95% confidence interval 7.44–235.1, p<0.001).
In the current cART era, physicians have a positive attitude
towards the treatment of ARL. The majority prefer to use
cART in combination with CHOP for ARL. The use and
perceived benefit of rituximab may be influenced by
interprovincial formulary differences and regional variation
in guideline recommendations.
Keywords AIDS-related lymphoma
.
Non-Hodgkin’s lymphoma
.
Diffuse large B cell lymphoma
.
Human immunodeficiency virus
.
Antiretroviral therapy
.
Chemotherapy
.
Rituximab
.
Survey methodology
Introduction
The introduction of combination antiretroviral therapy
(cART) for the treatment of human immunodeficiency
Ann Hematol (2007) 86:631–638
DOI 10.1007/s00277-007-0284-8
M. C. Cheung
:
K. R. Imrie
:
R. Buckstein
Department of Medicine, Division of Hematology/Medical
Oncology, Sunnybrook Health Sciences Centre,
University of Toronto,
Toronto, ON, Canada
H. A. Leitch
Department of Medicine, Division of Hematology,
St. Paul’s Hospital, University of British Columbia,
Vancouver, BC, Canada
L. Y. Park-Wyllie
:
T. Antoniou
Department of Family and Community Medicine,
St. Michael’s Hospital, University of Toronto,
Toronto, ON, Canada
L. Y. Park-Wyllie
Centre for Research on Inner City Health,
St. Michael’s Hospital, University of Toronto,
Toronto, ON, Canada
M. R. Loutfy
Department of Medicine, Division of Infectious Diseases,
Maple Leaf Medical Clinic,
University of Toronto,
Toronto, ON, Canada
M. C. Cheung (*)
Department of Medicine, Division of Hematology/Medical
Oncology, Toronto Sunnybrook Regional Cancer Centre,
2075 Bayview Avenue, T2-031,
Toronto M4N 3M5, ON, Canada
e-mail: matthew.cheung@utoronto.ca