Cord blood banking remains 'personal decision'

Cord blood can be used to treat a variety of diseases, including leukemia, by increasing the body’s natural immune system and increasing healthy blood count. A genetic match, either from the donor or a sibling, increases the chances of success.


More than a million units of cord blood are banked through private cord blood banks across the United States. Continuing research has shown that the stem cell rich blood can be used in the treatment of approximately 80 diseases, but private banking can cost several thousand dollars up front, plus an annual fee.
New parents have many decisions to make. Cloth diapers or disposable? Breastfeeding or formula? Increasingly, another decision presented is whether or not to bank a newborn’s cord blood.
“Donating cord blood for public use or storing it for a family’s private use is really a personal decision,” says Del Steckler, cord blood recruitment manager with Be the Match, a public banking network registry. “We like to give expectant parents the information so that they can then go and make the educated decision for their family.”


Umbilical cord blood, taken from the umbilical cord after birth, contains hematopoietic stem cells, similar to those found in bone marrow and peripheral blood. To date, it has been used to treat approximately 80 diseases. Cord blood can be banked through a public bank for any patients or at a private, or family, bank for the donor and immediate family. Less than 5 percent of all available cord blood is banked, says Morey Kraus, chief scientific officer with ViaCord, a family cord blood banking company based out of Massachusetts.


Despite the growing popularity, the practice is not met with unanimous support from the medical community, often due to the financial cost and likelihood of use. Many medical professionals encourage people to explore their options before making an educated decision.
“We’d like more people to know about what their options are so they can make decisions and have the availability of family banking and public banking,” Kraus says. “They should definitely have the options available to them.”


Umbilical cord blood


The first cord blood transplant was performed in 1988 on a patient with Fanconi anemia. Four years later, the first public bank was established in New York, and the first unit for family use was stored by the University of Arizona. The first family bank, Cord Blood Registry, was established in 1995.
Umbilical cord blood is collected after an infant’s cord is clamped and cut. The average unit is about 110 milliliters. Unlike embryonic stem cells, whose use is often controversial, the stem cells in cord blood, bone marrow and peripheral blood are considered adult stem cells and do not result in the destruction of an embryo.
“They are derived or donated from a person, or in this case, from the baby’s leftover umbilical cord blood,” says Bill Ward, director of cellular therapy services at Saint Luke’s Health System in Kansas City. “It’s kind of like blood donation.”
Cord blood can be used to treat a variety of diseases, including leukemia, by increasing the body’s natural immune system and increasing healthy blood count. A genetic match, either from the donor or a sibling, increases the chances of success.
“A vast majority of our transplants are used for patients with leukemia or lymphomas, but there are a lot of other hematological malignancies, immunodeficiencies, other inherited disorders that both adult donor and cord blood can be used for transplants,” says Merry Duffy, director of cord blood operations at Be the Match. “The vast majority will be leukemia and lymphoma.”


Public banking


Public cord blood banks are supplied through volunteer donors and made available to the public. They are utilized at a rate of about 3 percent a year, Ward says.
Through St. Luke’s Health System of Kansas City, donors must fill out a 10-page medical history on both parents, and the mother’s blood is tested prior to donation.
Donation is free and blood only can be taken from healthy, single births at hospitals affiliated with a public banking program. After the unit is collected, it is processed and tested before it is stored long term in liquid nitrogen.
“The percentage of cord blood that we get in the lab that actually goes into the bank has dropped in the last eight years,” Ward says. “If you can imagine people donating their cord blood, or people even privately banking their cord blood, about 10 percent of them would be worthy of being used for patient therapy out of a public bank.”
When there is a need for cord blood, organizations like Be the Match can help connect doctors with cord blood units. They work with a network of 19 public banks that in turn work with almost 200 hospitals, including St. Luke’s. Currently, Mosaic Life Care is not part of a public cord blood banking network, according to the hospital.
Be the Match has approximately 400,000 cord blood units available to be matched in the United States and 700,000 units worldwide.
“One of the biggest things we provide transplant centers is a list within a matter of a minute or so of donors or cord blood units to match their patient,” Duffy says. “It has saved them tons and tons of time doing all this searching on their own.”
In public banking, the donor and recipient processes are generally unrelated, although they do hear positive stories of successful donations and transplants through Be the Match, Duffy says.
“We do occasionally have stories about the patients from our transplant centers, as well as the cord blood banks sharing stories of their moms,” she says. “It’s those kind of stories that keep on inspiring us to do our work every day. The donor themselves have that really close connection to saving a life.”


Family banking


Some families choose to privately bank a newborn’s cord blood, especially if there is a known medical history of related diseases, Kraus says. Family banking ensures that the donor’s cord blood is available for autologous use on a donor or allogeneic use on a blood relative if a need arises.
ViaCord has approximately 350,000 units in storage, and has had approximately 320 units used for transplants to date, Kraus says. Approximately 60 percent of the banked blood that is used is utilized by a direct family member of a donor while 40 percent is utilized by the donor.
“We can’t guarantee that it will be used, but at least we are putting it in a bank where, if they want to come back to it, they can,” Kraus says.
Expectant parents typically decide if they’d like to do family banking at least a month before delivery, Kraus says. With ViaCord, a carrier will pick up the cord blood from any hospital and ship it to the lab where it arrives within 24 hours. Physicians are able to collect cord blood at Mosaic, according to the hospital.
While they do perform some quality measures before storing units, not all cord blood is usable by a donor if a need arises, Kraus says. With some diseases, such as acute lymphoblastic leukemia, the donor’s cord blood could contain contaminated cells that renders it unusable by the donor.
“You do not do an autologous transplant for that because there may be precancerous leukemia cells in the cord blood,” Kraus says. “... but if a sibling comes down with acute lymphoblastic leukemia, that sibling cord blood is potentially an excellent source for a sibling.”
Private banking typically costs between $1,500 and $2,500.
“To the degree that this is available for many diseases and blood disorders, the value proposition has been good but somewhat relatively low because the likelihood of use is relatively low,” Kraus says. “As the unit ages in inventory and as science moves forward, what we’ll see, we believe, is that the units will be used more and more frequently.”


The future


As clinical research continues to expand, future uses for cord blood may be developed. Trials have looked at the use of cord blood in patients with cerebral palsy and autism spectrum disorder, but no approved uses have been developed.
The American Academy of Pediatrics currently warns against banking cord blood on speculation for potential future, currently undiscovered, uses or as “biological insurance.”
“What we’re hopeful to see is increasing the uses of cord blood for different diseases. The big area of research right now is in regenerative medicine,” Duffy says. “We’re hoping that cord blood can play a big role there. That will quite significantly expand the number of patients that are able to receive a transplant.”
Before making a decision, expectant parents should do their own research and talk to their physician. Duffy encourages mothers to consider public donation, especially those in minority groups as those units are in higher demand.
“If they are interested either way, they should do their own research. Talking to their doctor is great,” Ward says. “If they have a good reason to save their cord blood, then they should. If they don’t, then it’s up to them whether they want to spend the money.”


Original Article


LFLN REF. 15092017, p. 118-122