For a few parents, saving their newborns’ umbilical cord blood is good insurance. For most, they shouldn't bank on it.
Expecting parents often ask pediatricians for advice about umbilical cord banking. This procedure has become widely available, and private cord blood banks have aggressively promoted their services. Pediatricians should be familiar with the controversies surrounding public versus private umbilical cord blood banking, as well as the recommendations of the American Academy of Pediatrics (AAP).1
A brief overview
Umbilical cord blood (UCB) is a rich source of hematologic stem cells, which can reconstitute bone marrow in the treatment of dozens of malignancies. It can also be used to treat numerous hematologic, metabolic, and immunologic disorders. Cord blood transplantation has numerous advantages over bone marrow transplantation. It is more readily accessible, carries less risk of transmitting disease, and is less likely to produce a graft-versus-host reaction that may compromise the transplant. Perhaps most importantly, it is more likely to produce a successful engraftment when transplantation is performed with partially mismatched HLA (human leukocyte antigens) grafts.
To date, over 6,000 successful umbilical cord blood transplants have been performed. This has produced one-year survival rates as high as 90% with HLA sibling-matched cord blood stem cell transplants, and as high as 80% with unrelated cord blood stem cells.2
One disadvantage of umbilical cord blood transplants is that they are slower to engraft, compared to marrow transplants. In addition, the amount of useable blood that can be collected following a birth of a child is usually a tenth of what can be collected from a typical adult bone marrow harvest. This limits UCB transplants to children, adolescents and small adults. However, if ongoing research with combined cord blood units proves successful, eventually UCB transplants may one day be used routinely for adults as well.3
Public vs. private banks
The first unrelated public cord blood banking program was started at the New York Blood Center in 1992. Today there are dozens of public cord blood banks available. In 2005 Congress passed the "Stem Cell Therapeutic and Research Act," which funded and tasked the Health Resource and Services Administration to develop a national public cord blood banking program with 150,000 cord blood donations over five years. A complete list of public cord blood banks appears on the National Bone Marrow Donor Program Web site at www.mar
Patients wishing to donate umbilical cord blood to a public bank are subjected to a rigorous screening process, which includes an extremely thorough family history to exclude familial hematologic and immunologic abnormalities. Patients may not donate if there is a history of exposure to live virus vaccines within three months of delivery, exposure to drugs of abuse, high-risk sexual activity, a tattoo within the last year, or if they are a medication-dependent diabetic.3
In addition to public cord banks, there are many private banks that encourage parents to store umbilical cord blood. This blood could be used for autologous transplantation should the child develop a medical condition amenable to such treatment, or for directed or allogeneic use by a sibling or parent with a condition such as hemoglobinopathy, marrow failure syndrome, congenital immunodeficiency, or metabolic disorder. Private cord banks charge up to $1,800 for the initial collection and processing, and approximately $150 per year for storage.3
There is much controversy surrounding private cord banks that claim autologous cord banking is a form of "biological insurance" that can be used by the child in future. While cord blood does contain pluripotent stem cells that can differentiate into other tissue types, the utility of such cells in conditions such as heart disease, diabetes, stroke, and Alzheimer's disease are still being investigated. There is a possibility that autologous cord blood transplantation may be beneficial in these or other disorders, but it is still speculation.1 Overall, the estimated chance of an individual needing an autologous transplant of umbilical cord blood is 1:2,700.3 It should also be noted that oncologists who treat leukemic children avoid autologous transplants of cord cells for such patients, because premalignant changes in stem cells are present in the cord blood.1