Physician perceptions and preferences in the treatment of acquired immunodeficiency syndrome (AIDS)-related lymphoma.
The optimal management of acquired immunodeficiency 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 regression analysis, use of rituximab was predicted only by location of practice (province); physicians from the province 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.
Cheung
Matthew C
MC
Department of Medicine, Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. matthew.cheung@utoronto.ca
Imrie
Kevin R
KR
Leitch
Heather A
HA
Park-Wyllie
Laura Y
LY
Buckstein
Rena
R
Antoniou
Tony
T
Loutfy
Mona R
MR
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D002170:Canada; D002755:Choice Behavior; D003520:Cyclophosphamide / Q000627:therapeutic use; D003625:Data Collection; D019468:Disease Management; D004317:Doxorubicin / Q000627:therapeutic use; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy*; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D014750:Vincristine / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone