Maternal Diet During Pregnancy and its Association with Medulloblastoma in Children: A Children’s Oncology Group Study (United States)

Fruit, vegetables, vitamin C, and folate during pregnancy have been suggested as protective factors for medulloblastoma/primitive neuroectodermal tumor (PNET), a common brain tumor in children. The authors sought to replicate these findings and investigate other aspects of diet. Mothers of 315 cases under age six at diagnosis and 315 controls were interviewed about their pregnancy diet. The authors observed modest, inverse associations for fruits/juices (odds ratio (OR) for highest compared to lowest category = 0.6, 95% confidence interval (CI): 0.3, 1.1) and vitamin C (OR = 0.6, 95% CI: 0.4, 1.1). In contrast to the previous study, folate and vegetables showed no association. As hypothesized, cured meats were not associated with medulloblastoma/PNET, in contrast to other childhood brain tumors. An inverse association with nonfresh peaches and similar fruits (OR = 0.5, 95% CI: 0.3, 0.8) and a positive association with nonchocolate candy (OR = 1.7, 95% CI: 1.0, 3.0) replicated previous findings. French fries (OR = 2.4, 95% CI: 1.2, 4.9) and chili peppers (OR = 1.8, 95% CI: 1.0, 3.0) were associated with medulloblastoma/PNET. The results suggest that some aspects of diet are worthy of further research.     

Children with DIPG and high-grade glioma treated with temozolomide,irinotecan, and bevacizumab: the Seattle Children’s Hospital experience

Journal of Neuro-Oncology - Stereotactic radiosurgery (SRS) is an emerging treatment for patients with multiple brain metastases (BM). The present work compares the SRS of multiple brain metastases...     

Observational Study on Patient’s Satisfactions and Quality of Life (QoL) Among Cancer Patients Receiving Treatment with Palliative Care Intent in a Tertiary Hospital in Malaysia

The main objective of palliative treatment for cancer patients has been to maintain, if not improve, the qualityof life (QoL). There is a lack of local data on satisfaction and QoL among cancer patients receiving palliativetreatment in Malaysia. This study covers patients with incurable, progressive cancer disease receiving palliativetreatment in a teaching hospital in Kuala Lumpur, comparing the different components of QoL and correlationswith patient satisfaction. A cross-sectional survey using Malay validated SF36 QoL and PSQ-18 (Short Form)tools was carried out between July 2012 -January 2013 with 120 cancer patients receiving palliative treatment,recruited into the study after informed consent using convenient sampling. Results showed that highest satisfactionwere observed in Communication Aspect (50.6±9.07) and the least in General Satisfaction (26.4±5.90). TheMental Component Summary (44.9±6.84) scored higher when compared with the Physical Component Summary(42.2±7.91). In this study, we found that patient satisfaction was strongly associated with good quality of lifeamong cancer patients from a general satisfaction aspect (r=0.232). A poor significant negative correlation wasfound in Physical Component (technical quality, r=-0.312). The Mental Component showed there was a poornegative correlation between time spent with doctor (r=-0.192) and accessibility, (r=-0.279). We found that feelingat peace and having a sense of meaning in life were more important to patients than being active or achievinggood physical comfort. More studyis needed to investigate patients who score poorly on physical and mentalcomponent aspects to understand their needs in order to achieve better cancer care.     

History of periodontal disease diagnosis and lung cancer incidence in the Women’s Health Initiative Observational Study

Purpose

While some evidence suggests that periodontal disease (PD) might be positively associated with lung cancer, prospective studies in women are limited. Previous findings may reflect residual confounding by smoking. The study aims to determine whether history of PD diagnosis is associated with incident lung cancer in a large cohort of postmenopausal women.

Methods

Prospective analyses were conducted in a cohort of 77,485 postmenopausal women enrolled in the Women’s Health Initiative Observational Study. History of PD (prevalence of 26.1 %) was self-reported, and 754 incident lung cancer cases occurred during an average 6.8 (SD ± 2.6) years of follow-up. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).

Results

Overall, PD was positively associated with lung cancer risk after adjusting for detailed smoking history including smoking status and pack-years of smoking (HR 1.24, 95 % CI 1.07–1.45). There was a positive additive interaction between PD with pack-years of smoking (p = 0.02), suggesting a potential synergistic effect between PD and smoking intensity on lung cancer. The association between PD and lung cancer was stronger in former smokers. When restricted to never-smokers, PD was not associated with lung cancer (HR 1.02, 95 % CI 0.68–1.53).

Conclusions

Periodontal disease was not independently associated with lung cancer in non-smoking postmenopausal women. However, smoking and PD jointly increased lung cancer risk beyond that expected from the sum of the each effect separately. The potential synergism between PD and smoking on lung cancer warrants further examination.     

Men’s Knowledge of and Behavior toward Mammography Screening: A Cross-Sectional Study

Background: Breast cancer (BC) is a public health problem that affects many populations worldwide. Women’s health care behavior, including seeking mammography screening, might be affected by men, especially in conservative Arab societies. Few studies have investigated men’s behavior toward mammography for female relatives. The main aims of this study were (i) to evaluate men’s knowledge about mammography screening and (ii) to assess men’s behavior toward women regarding mammogram screening and the factors influencing their behavior. Methods: A cross-sectional study was conducted among male residents of the five main geographic areas of Saudi Arabia. Data were obtained with a self-administered questionnaire. In addition to sociodemographic data, the questionnaire assessed respondents’ general knowledge about mammograms, their behavior toward female family members who use mammography, and their perceptions about awareness campaigns. Results: A total of 9691 male respondents were included in the study. The majority (79%) recommended mammography to their female family members. Multiple factors were significantly associated with men recommending mammograms, including age (p <0.01), education (p <0.01), employment status (p <0.01), and region (p <0.01). Only 33.8% of the participants had a high knowledge score about mammography. Approximately 45% of respondents reported that BC awareness campaigns were weak, while 48% were not aware of BC screening programs. Conclusions: Despite their positive behavior in recommending mammograms to female relatives, men exhibited a notable lack of knowledge about mammography. Establishing national programs and educational campaigns for men to explain the benefits of screening and access to free mammography are essential.     

Incidence and Characteristics of Childhood Hodgkin’s Lymphoma in Greece: A Nationwide Study (Greece)

Objectives To estimate the incidence and epidemiological profile of childhood (0–14 years) Hodgkin’s lymphoma in Greece derived by the network of childhood Hematology–Oncology departments on the basis of all 95 newly diagnosed cases during a seven-year period. Methods Seventy-one of these cases were individually age and gender matched to an equal number of controls. Results The incidence of childhood Hodgkin Lymphoma reached a relatively high figure of 7.8 per million children-years, with an age distribution (2.2 for children 0–4; 6.3 for those 5–9 and 13.9 for those 10–14-years-old) and male to female ratio (1.7:1) similar to that reported from other cancer registries. Childhood Hodgkin’s lymphoma was more common among children living in less crowded quarters (odds ratio (OR): 6.5 and 95% confidence intervals (95% CI): 1.4–30.7), among those who have changed residence 60 to 18 months before the onset of the index disease (OR: 4.4, and 95% CI = 1.4–14.0), among those whose families owned a cat (OR: 5.5, 95% CI = 1.2–25.6) but not among those whose families owned a dog and marginally more common, among those with a history of infectious mononucleosis (OR: 5.0, 95% CI = 0.6–42.8). Conclusions Our results point to infectious agent(s) as playing an etiological role but do not allow discrimination among the delayed establishment of the herd immunity hypothesis, the population mixing hypothesis or that invoking transmission of the agent(s) from the non-human reservoir. The Childhood Hematology–Oncology Group. Maria Moschovi, Hematology–Oncology Unit, First Department of Pediatrics, Athens University Medical School, ‘Aghia Sophia’ General Children’s Hospital, Athens, Greece Fani Athanassiadou- Piperopoulou, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital, Greece Sophia Polychronopoulou, Department of Pediatric Hematology–Oncology, ‘Aghia Sophia’ General Children’s Hospital Athens, Greece Apostolos Pourtsidis, Department of Pediatric Hematology–Oncology, ‘Pan.&Agl. Kyriakou’ Children’s Hospital Athens, Greece Maria Kalmanti, Department of Pediatric Hematology–Oncology, University Hospital of Heraklion, Heraklion, Greece     

Examination with the Health Belief Model of Women’s Attitudes to Cervical Cancer and Early Diagnosis in Turkey: A Qualitative Study

Objective: The study was planned with the purpose of examining women’s attitude to the health belief model,and their attitudes and behavior towards cervical cancer and early diagnosis. Materials and methods: Thequalitative (case-study) method was used in this study. Data were collected between October 2010 and November2010 using a purposive sampling method for qualitative research. The study sample constituted from 11 womenbeing treated at two clinics, between the ages of 15 and 49, who were married, and who had not previously had apap-smear test. Data collection tool consist of two parts that are an “Information Form” identifying women andsemi-structured “Interview Form”. Interviews were done face to face by using in-depth interviews technique.Semi-structured interview was recorded in audio recording device. Content analysis method was used to assessthe data. Results: Awareness is insufficient that of women about cervical cancer prevention and early diagnosis,there is less fear of cervical cancer. Information of women is inadequate about early diagnosis and preventionof cervical cancer and there are various barriers about early detection and prevention. According to contentanalysis, three main themes emerge. These are the themes of belief, knowledge and barriers. Conclusions: Itbecame clear from interviews carried out in line with the health belief model why women did not exhibit positivehealth behavior. It is recommended that this study should be repeated in other parts of Turkey. In addition, thisstudy can serve as a guide to quantitative studies in wider communities.     

The expression of Ki-67 and Bcl-2 in hodgkin’s lymphoma: Correlation with the international prognostic score and bulky disease

The prognosis of Hodgkin’s lymphoma has been improved over last 10 yr due to identification of prognostic parameters. These factors may predict the clinical outcome and therefore may have influence on the selection of appropriate treatment. In a cohort of 40 patients with Hodgkin’s lymphoma of nodular sclerosis subtype, treated with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) regimen, we analyzed prognostic relevance of the expression of Ki-67 and Bcl-2 at diagnosis as well as other clinical parameters: International Prognostic Score, bulky disease, tissue eosinophilia, and high erythrocyte sedimentation rate. Significance was tested according to response rate and overall survival. Patients with a high proliferative fraction (Ki-67 > 50%) had worse overall survival compared with those with low proliferation, 56% vs 91%. There was a correlation between Ki-67 positivity and the achievement of complete remission. Cox’s multivariate model revealed that Ki-67 positivity at threshold of 50% was a significant independent prognostic factor. The Bcl-2 expression in less than 50% of tumor cells was detected in 65.5% of patients, and in a majority of cases it was associated with complete remission. Patients with high IPS had more progressive disease and shorter survival. Bulky disease, tissue eosinophilia, and high erythrocyte sedimentation rate had no significant influence on complete remission and survival. However, there was a marked divergence in survival curves after 4 yr follow-up for each of these parameters. Patients with high Ki-67, IPS > 3, bulky disease, tissue eosinophilia, and high sedimentation rate are at a higher risk of treatment failure and relapse and therefore might be eligible for other aggressive therapeutic approach.     

Loss of Heterozygosity Analysis of Chromosome 17p13.1–13.3 and its Correlation with Clinical Outcome in Medulloblastomas

Cytogenetic and molecular genetic studies have shown that deletions on the short arm of chromosome 17 distal to p53 locus are the most common genetic events in medulloblastoma. We examined the occurrences and frequencies of allelic deletions on chromosome 17p13.1-13.3 by loss of heterozygosity (LOH) analysis to investigate the possible involvement of 17p13.1-13.3 in medulloblastoma development. We also performed survival analysis to determine whether LOH analysis of 17p13.1-13.3 can be used to predict prognosis in medulloblastoma. Loss of heterozygosity was analyzed by polymerase chain reaction on chromosome 17p13.1-13.3 using three microsatellite markers, TP53 on 17p13.1, D17S796 on 17p13.1-13.2, and D17S1574 on 17p13.3, in 17 medulloblastoma DNAs extracted either from archival tissue or fresh frozen tissue specimens. Allelic deletions were detected in five of 17 informative cases (29%) on TP53, eight of 17 informative cases (47%) on D17S796, and four of 17 informative cases (24%) on D17S1574. Overall, nine of 17 cases (53%) showed LOH on chromosome 17p13.1-13.3. The 5-year progression free survival (PFS) and 5-year overall survival rates were identical (59%). The 5-year PFS for nine medulloblastoma patients with LOH on 17p13.1-13.3 was 56%, and the 5-year PFS for eight medulloblastoma patients without LOH on 17p13.1-13.3 was 63%. In our survival analysis, we did not find a significant association between survival and LOH on 17p13.1-13.3. Our results support the notion that deletions of chromosome 17p13.1-13.3 may be involved in the pathogenesis of medulloblastoma. From survival analysis, we conclude that LOH on chromosome 17p13.1-13.3 may not be a significant predictor of prognosis in medulloblastoma.     

Pegfilgrastim Versus Filgrastim for Primary Prophylaxis of Febrile Neutropenia in Patients with non-Hodgkin’s Lymphoma: A Cost-Effectiveness Study

Aim: One method to deal with febrile neutropenia is the use of granulocyte colony stimulating factors (G-CSFs). Pegfilgrastim or Filgrastim injection can lead to a reduction in febrile neutropenia and severe neutropenia in patients receiving chemotherapy. This study aimed to compare the cost-effectiveness of using Pegfilgrastim, 3-day Filgrastim and 1-day Filgrastim medication strategies for the primary prophylaxis of febrile neutropenia in patients with relapsed non-Hodgkin’s lymphoma after salvage chemotherapy who referred to two referral centers affiliated to Iran, Shiraz University of Medical Sciences in 2014. Method: This cost-effectiveness study was conducted on 131 patients with non-Hodgkin’s lymphoma. The outcome of the study was the prevention of febrile neutropenia. The cost data were collected from the health payer’s perspective for each medication strategy by reviewing the patients’ medical records and using expert opinion. The results were presented in terms of the incremental cost-effectiveness ratio (ICER) and the sensitivity analysis was used to assess the robustness of results. In this study, the collected data were analyzed using Excel 2007 and Tree-age 2011. Results: The results showed that the degrees of febrile neutropenia prevented by Pegfilgrastim, 3-day Filgrastim and 1-day Filgrastim strategies were 0.97, 0.95 and 0.83, respectively, and the average annual costs of hospitalization per patient were, 5299, 4959 and 5808 PPP$. Conclusion: The results showed that while 1-day Filgrastim was absolutely predominant, using the 3-day Filgrastim and Pegfilgrastim strategies were more cost-effective. Therefore, they can be recommended respectively as the first and second treatment priorities in patients with non-Hodgkin’s lymphoma after salvage chemotherapy.     

A family-based study of gene variants and maternal folate and choline in neuroblastoma: a report from the Children’s Oncology Group

Purpose

Neuroblastoma is a childhood cancer of the sympathetic nervous system with embryonic origins. Previous epidemiologic studies suggest maternal vitamin supplementation during pregnancy reduces the risk of neuroblastoma. We hypothesized offspring and maternal genetic variants in folate-related and choline-related genes are associated with neuroblastoma and modify the effects of maternal intake of folate, choline, and folic acid.

Methods

The Neuroblastoma Epidemiology in North America (NENA) study recruited 563 affected children and their parents through the Children’s Oncology Group’s Childhood Cancer Research Network. We used questionnaires to ascertain pre-pregnancy supplementation and estimate usual maternal dietary intake of folate, choline, and folic acid. We genotyped 955 genetic variants related to folate or choline using DNA extracted from saliva samples and used a log-linear model to estimate both child and maternal risk ratios and stratum-specific risk ratios for gene–environment interactions.

Results

Overall, no maternal or offspring genotypic results met criteria for a false discovery rate (FDR) Q-value <0.2. Associations were also null for gene–environment interaction with pre-pregnancy vitamin supplementation, dietary folic acid, and folate. FDR-significant gene–choline interactions were found for offspring SNPs rs10489810 and rs9966612 located in MTHFD1L and TYMS, respectively, with maternal choline dietary intake dichotomized at the first quartile.

Conclusion

These results suggest that variants related to one-carbon metabolism are not strongly associated with neuroblastoma. Choline-related variants may play a role; however, the functional consequences of the interacting variants are unknown and require independent replication.

     

Breast-feeding and Wilms Tumor: A Report from the Children’s Oncology Group

Objective Previous research has shown that breast-feeding offers many nutritional benefits to children including protection against infection and possibly a decreased risk of childhood cancer. We investigated the association between breast-feeding and Wilms tumor, a childhood kidney tumor. Methods We used data from a large case-control study in the United States and Canada. Cases were children under age 16 years who were diagnosed with Wilms tumor from 1999 to 2002 and were participating in the National Wilms Tumor Study. Controls were identified by random-digit dialing and were age and region matched to cases. Mothers of 501 cases and 480 controls provided information on breast-feeding by telephone interviews. Results Breast-feeding was associated with a reduced risk of Wilms tumor [adjusted odds ratio (OR) = 0.7; 95% confidence interval (CI) = 0.5–0.9]. Longer duration did not provide any additional reduction in risk. When stratified by maternal education, breast-feeding lowered risk among children whose mothers had less than a college education (OR = 0.6; 95% CI = 0.4–0.8) but not for mothers who had a college degree or more (OR = 1.1; 95% CI = 0.6–1.9). Conclusions The results of this study are suggestive of an association between breast-feeding and Wilms tumor, but further research is needed to confirm this relationship. Supported in part by NCI R01CA75385 and by a grant from the National Institute of Environmental Health Sciences (P30ES10126).     

Pharmacokinetics and pharmacogenomics of daunorubicin in children: a report from the Children’s Oncology Group

Purpose

We explored the impact of obesity, body composition, and genetic polymorphisms on the pharmacokinetics (PK) of daunorubicin in children with cancer.

Patients and methods

Patients ≤21 years receiving daunorubicin as an infusion of any duration <24 h for any type of cancer were eligible. Plasma drug concentrations were measured by high-performance liquid chromatography. Body composition was measured by dual-energy X-ray absorptiometry. Obesity was defined as a BMI >95 % for age or as body fat >30 %. NONMEM was used to perform PK model fitting. The Affymetrix DMET chip was used for genotyping. The impact of genetic polymorphisms was investigated using SNP/haplotype association analysis with estimated individual PK parameters.

Results

A total of 107 subjects were enrolled, 98 patients had PK sampling, and 50 patients underwent DNA analysis. Population estimates for daunorubicin clearance and volume of distribution were 116 L/m²/h ± 14 % and 68.1 L/m² ± 24 %, respectively. Apparent daunorubicinol clearance and volume of distribution were 26.8 L/m²/h ± 5.6 % and 232 L/m² ± 10 %, respectively. No effect of body composition or obesity was observed on PK. Forty-four genes with variant haplotypes were tested for association with PK. FMO3-H1/H3 genotype was associated with lower daunorubicin clearance than FMO3-H1/H1, p = 0.00829. GSTP1*B/*B genotype was also associated with lower daunorubicin clearance compared to GSTP1*A/*A, p = 0.0347. However, neither of these associations was significant after adjusting for multiple testing by either Bonferroni or false discovery rate correction.

Conclusions

We did not detect an effect of body composition or obesity on daunorubicin PK. We found suggestive associations between FMO3 and GSTP1 haplotypes with daunorubicin PK that could potentially affect efficacy and toxicity.     

Prevention and treatment of hyperuricemia with rasburicase in children with leukemia and non-Hodgkin’s lymphoma

To prevent acute renal failure in children at risk for developing tumor lysis syndrome due to acute lymphoblastic leukemia or non-Hodgkin’s lymphoma treated according to international BFM protocols, we investigated recombinant urate oxidase (rasburicase) in the first Central European openlabeled, prospective, multicenter phase IV trial. Rasburicase was administered intravenously, at 0.2 mg/kg for 5 consecutive days to 36 patients. Blood levels of uric acid, creatinine, phosphorus, calcium, lactate dehydrogenase and complete blood count were measured daily during rasburicase treatment and on days 6, 7 and 12. Initial uric acid level decreased significantly by 4 hours (from 343 μmol/L to 58 μmol/L, p<0.001), except for one steroid-resistant patient who required hemodialysis on day 14 after having introduced combined cytostatic treatment. Comparing the data of a subgroup of 12 patients receiving rasburicase with that of a historic cohort of 14 patients treated with allopurinol indicated the superiority of rasburicase over allopurinol in prophylaxis and treatment of hyperuricemia in children with leukemia and lymphoma. Both authors contributed equally to this work. The study of the investigational new drug was approved and it was provided by Sanofi-Synthelabo Inc., Budapest, Hungary. This work was supported by the grant of the Health Science Council of the Ministry of Health, Republic of Hungary (ETT) No. 225.     

Feasibility and dose discovery analysis of zoledronic acid with concurrent chemotherapy in the treatment of newly diagnosed metastatic osteosarcoma: A report from the Children’s Oncology Group

AimPatients with metastatic osteosarcoma (OS) have a poor outcome with conventional therapies. Zoledronic acid (ZA) is a third-generation bisphosphonate that reduces skeletal-related events in many adult cancers, and pre-clinical data suggest a possible benefit in OS. This study assessed the maximum tolerated dose (MTD) and the feasibility of ZA when combined with chemotherapy in patients with metastatic OS.Patients and MethodsPatients with a histological diagnosis of OS were eligible if they were <40 years of age, had initially metastatic disease and met organ function requirements. Treatment combined surgery and a conventional chemotherapy regimen. ZA was given concurrent with chemotherapy for a total of eight doses over 36 weeks. Three dose levels of ZA were tested: 1.2 mg/m² [max 2 mg], 2.3 mg/m² [max 4 mg] and 3.5 mg/m² [max 6 mg]. The MTD was determined during induction. Six patients were to be treated at each dose level, with an additional six patients treated with the MTD to help assess post-induction feasibility.ResultsTwenty-four patients (median age 13.5 years [range, 7–22]; 16 females) were treated. Five patients experienced dose-limiting toxicities (DLTs) during induction, including three patients treated with 3.5 mg/m². DLTs included hypophosphatemia, hypokalemia, hyponatremia, mucositis, limb pain and limb oedema. There were no reports of excessive renal toxicity or osteonecrosis of the jaw. The MTD was defined as 2.3 mg/m² (max 4 mg).ConclusionsZA can be safely combined with conventional chemotherapy with an MTD of 2.3 mg/m² (max 4 mg) for patients with metastatic osteosarcoma.     

Extranodal Non-Hodgkin’s Lymphomas - A Retrospective Review of Clinico-Pathologic Features and Outcomes in Comparison with Nodal Non-Hodgkin’s Lymphomas

Objective: The primary objective of this study was to analyze the anatomic distribution, clinical featuresand outcome of Diffuse large B-cell lymphoma (DLBCL) patients according to the primary site (extranodal vs.nodal) with applicability of International Prognostic Index (IPI). Methodology: A retrospective review (1988 to2004) of 557 cases of DLBC. Results: The median age was 48.7 ± 15.3 years; M:F ratio was 2:1. The distributionaccording to the primary site was: lymph node (N-NHL), 322 cases (58%) of which 145(44%) were stage IV, 76(23%) stage III, 60 (18%) stage II and 47 (15%) stage I. The extra nodal sites (EN-NHL) 235 (42%) casesincluded gastro-intestinal tract (44%), upper aerodigestive tract (19%), bones (8%), spine (5%), and unusualsites less than 3% each as breast, CNS, testis, lungs and skin. The median survival rate was 4.8 years and 6.3years in N-NHL and EN-NHL respectively. In the latter this varied greatly depending on the primary site andstage of disease at presentation. In the univariate analysis factors associated with good prognosis were: age lessthan 60 years, early stage (I-II), extranodal involvement primarily gastric or bone, 0-1 extranodal site, 0-1performance status, lack of B symptoms and normal LDH level. In the multivariate analysis age, performancestatus, stage of disease and level of LDH were the main variables predicting overall survival; no nodal or extranodalsite maintained their prognostic value. Conclusion: Patients with EN-NHL present more frequently with earlystage disease then those with N-NHL; overall survival in both groups largely depended on IPI and not on the siteof origin of the malignancy.     

A case–control study of childhood brain tumors and fathers’ hobbies: a Children’s Oncology Group study

Objective  A comprehensive case–control study was conducted to evaluate parental risk factors for medulloblastoma (MB) and primitive neuroectodermal tumor (PNET). This analysis was conducted to evaluate associations between fathers’ hobbies and risk of their children developing MB/PNET. The hobbies chosen for study were those with similar exposures as occupations associated with childhood cancers. Methods  Cases were 318 subjects under six years of age at diagnosis between 1991 and 1997 and registered with the Children’s Cancer Group. An equal number of controls were selected through random digit dialing and individually matched to cases. Results  In multivariate analyses, a significant association was seen for lawn care with pesticides [during pregnancy: odds ratio (OR) = 1.6, 95% confidence interval (CI): 1.0, 2.5; after birth: OR = 1.8, 95% CI: 1.2, 2.8] and a weak association was seen for stripping paint [during pregnancy: OR = 1.4, 95% CI: 0.8, 2.6; after birth: OR = 1.4, 95% CI: 0.7, 2.6]. Conclusions  This study suggests that household exposures from hobbies, particularly pesticides, may increase risk of MB/PNET in children; previous research has been mostly limited to occupational exposures.