Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. The U.S. Surveillance Epidemiology and End Results (SEER) registry reports that Hispanic children have the highest incidence of ALL, however, it is unclear if this is due to genetic factors, unique environmental exposures, or both. Previous reports have shown an association between CYP1A1 variants and ALL.Methods: To explore the contribution of CYP1A1 polymorphisms to ALL susceptibility in different ethnic groups, we conducted a case-control analysis in Caucasian, Hispanic, and African-American children.Results: Increased risk of developing ALL was found in the whole sample group for homozygosity of variant alleles at CYP1A1*2C (OR 2.51, 95% CI 1.18-5.33, P ¼ 0.016) and CYP1A1*2B (OR 3.24, 95% CI 1.43-7.34, P ¼ 0.005). Stratified analyses showed increased risks in the Hispanic group (CYP1A1*2A, OR 2.70, 95% CI 1.27-5.74, P ¼ 0.010; CYP1A1*2C, OR 2.47, 95% CI 1.13-5.38, P ¼ 0.023; and CYP1A1*2B, OR 3.28, 95% CI 1.40-7.69, P ¼ 0.006) but not for the other ethnic groups. Hispanic control subjects were significantly more likely to be carriers of variant alleles as compared to Caucasians (P < 0.0001) and African Americans (P ¼ 0.005).Conclusions: Our study suggests that polymorphisms in CYP1A1 may contribute to the increased risk of ALL in Hispanic children due to both their impact on leukemia susceptibility and the increased prevalence of the at-risk alleles in the Hispanic population.Impact: Our study provides a novel and specific link between CYP1A1 polymorphisms and ethnic influence on ALL risk that may help explain varying susceptibilities across groups to environmental toxins. Cancer Epidemiol Biomarkers Prev; 20(7); 1537-42. Ó2011 AACR.

Pediatric palliative care requires the orchestrated efforts of a multidisciplinary care team of medical staff, nursing, psychosocial staff, and other healthcare professionals. Augmenting this team are support staff including financial counsellors, volunteers, secretaries, and others not involved in the direct administration of medical services. Prior research in palliative care has studied the perceptions, training, and professional resources of medical staff and social workers, but neglected to investigate such factors in support staff. Our study examined the effect of involvement in end-of-life pediatric care on support staff. We found this community to consist of a heterogeneous population of hospital employees, who develop numerous, substantial, direct interactions with dying children and their families. They indicated that such experiences had caused some adverse outcomes in their lives, and that few felt they had sufficient knowledge or training in palliative care. Our respondents voiced noteworthy opinions on symptom control, cultural issues, and spirituality pertinent to pediatric palliative care. Support staff playa key role in the palliative care team; research and resources need to be directed to educating, training, and supporting them. Resume I Les soins palliatifs p8diatriques necessitent les efforts orchestres d'une equipe multidisciplinaire tels les rnedecins, infirmieres, psychologuas et autres professionnels de la sante. Acetta equipe se joint Ie personnel de soutien tels les preposes aux finances, les benevoles, les secretaires et tous les autres qui ne participent pas directement aux soins aux malades. Les recherches anterieures en soins palliatifs se sont penchees sur les perceptions, la formation et les ressources professionnelles du personnel medical et des travailleurs sociaux mais elles ont neglige des facteurs tel Ie personnel de soutien. Notre etude porte sur les effets de la dispensation des soins pediatriques en fin de vie sur Ie personnel de soutien. Nous avons trouve que chez ce groupe heteroqene d'ernployes d'hopltal, plusieurs avaient developpe des liens importants et des interactions importantes avec les enfants mourants et leur famille. lis ont mentlonne que de telles experiences avaient eu des effets adverses dans leur vie et tres peu sentaient qu'ils pos-sedaient suffisamment de connaissance ou de formation en soins palliatifs pediatrlques. lis ont exprime des opinions valables sur Ie contole de la douleur; les differences culturelles et la spiritualrte propre aux soins palliatifs pediatriques. Le personnel de soutien joue un role-cle dans l'equlpe de soins, et il faudrait augmenter les ressources afin de les aider, les former et les entrainer.

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Childhood cancers continue to be challenging clinical entities whose etiology, demographic characteristics, clinical progression, treatment efficacy, and outcomes remain incompletely understood. Research suggests that multiple environmental and genetic factors may play crucial roles in the pathophysiology of many of these malignancies. Recent attention has been directed to the role of carcinogen metabolizing enzymes in the etiology and progression of cancer in both adults and children due to their multitude of polymorphic variants and their intimate interaction with environmental factors. In particular, xenobiotic metabolizing enzymes (XME), which are intimately involved in the activation and deactivation of many environmental carcinogens, have become an area of significant interest. Traditionally, these enzymes have been classified into either phase I or phase II enzymes depending on their substrates, activity, and occasionally based on their sequence in the metabolic pathways, and have been demonstrated to have numerous polymorphic variants. Phase I enzymes predominantly consist of cytochrome enzymes responsible for mixed function oxidase activity, whereas phase II enzymes are frequently conjugation reactions necessary for drug metabolism or the further metabolism of phase I enzyme products. Current research has discovered numerous interactions between polymorphisms in these enzymes and changes in cancer susceptibility, treatment efficacy, and clinical outcomes in childhood cancer. Furthermore, studies of polymorphisms in these enzymes have demonstrated to have synergistic/antagonistic interactions with other XME polymorphisms and demonstrate variable influences on disease pathophysiology depending on the patient's ethnic background and environmental milieu. Continuing research on the role of polymorphisms in phase I and phase II enzymes will likely further elucidate the intimate role of these polymorphisms with environmental factors in the etiology of childhood cancer.