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Some parents-to-be are sold on the advertising that banking their child’s cord blood could potentially treat an array of diseases the child, or his siblings, could encounter in their lives. Other parents-to-be may find all the promises too good to be true.
Stem cells’ role is critical for regenerative medicine. A stem cell is a special type of cell because it is the basis for all the other cells in our bodies. Stem cells have the ability to develop into one of many different types of cells. This process of a stem cell becoming a specific type of cell like a skin cell, blood cell or bone cell is known as differentiation. The other unique ability of stem cells is to replicate quickly. Combined, these abilities can quickly replenish different types of cells, making stem cells a driving factor or major enhancement in the healing process.
New England Cord Blood Bank was founded in 1971 and is one of the pioneers in processing and cryopreservation of human cells and tissue. The company is continuing to expand its research and development center.
Finally, there is a significant lack of regulation for umbilical cord blood banking. The lack of quality control, in turn, affects the quality of the specimen available for transplant. Some cord blood banks have submitted to voluntary accreditation, but the process of accreditation varies from bank to bank, whether public or private (McGuckin & Forraz, 2008; Moise, 2005).
3. Heart disease. It’s the leading cause of death in the United States, and stem cells may provide some relief. Research is underway to see if injecting the cells into the heart could help regenerate heart muscle damaged by, for example, a heart attack. Again, researchers have reported success in rodents.
In recent years, umbilical cord blood, which contains a rich source of hematopoietic stem and progenitor cells, has been used successfully as an alternative allogeneic donor source to treat a variety of pediatric genetic, hematologic, immunologic, and oncologic disorders. Because there is diminished risk of graft-versus-host disease after transplantation of cord stem cells using matched related donors, the use of less-than-completely matched HLA cord blood stem cells may incur less risk of graft-versus-host disease than mismatched cells from either a related or unrelated “walking” donor, although this remains to be proven. Gene-therapy research involving modification of autologous cord blood stem cells for the treatment of childhood genetic disorders, although experimental at the present time, may prove to be of value. These scientific advances have resulted in the establishment of not-for-profit and for-profit cord blood–banking programs for allogeneic and autologous cord blood transplantation. Many issues confront institutions that wish to establish or participate in such programs. Parents often seek information from their physicians about this new biotechnology option. This document is intended to provide information to guide physicians in responding to parents’ questions about cord blood donation and banking and the types and quality of cord blood banks. Provided also are recommendations about appropriate ethical and operational standards, including informed consent policies, financial disclosures, and conflict-of-interest policies for physicians, institutions, and organizations that operate or have a relationship with cord blood–banking programs.
So what are your options? You have three choices. One is to store the cord blood with a private company at a cost to you ranging from $1,500 to $2,500 and an annual storage fee in the ballpark of $125. Secondly, you can donate the cord blood to a public bank, if there is one working with your hospital, and your doctor is on board with the idea. There are also public banks that accept mail-in donations, if you register during your second trimester and your doctor is willing to take a short training class on-line. Zero cost to you. The third option is to do nothing and have the cord blood, umbilical cord, and placenta destroyed as medical waste.
Properly preserved cord blood is long-lasting. Cord blood is stored in a nitrogen freezer (the same technology used to freeze donated sperm), so it can last for a long time. “The scientist who first developed cord blood preservation methods in 1990 has confirmed that some of the first specimens he stored 23 plus years ago are just as potent as fresh cord blood,” says Mary Halet, Director, Central Region at Be The Match, which is operated by the National Bone Marrow Foundation.
Please tell us a little about yourself. A Newborn Stem Cell Educator may call to discuss your options and answer any questions you may have. You may also receive additional information about saving or donating newborn stem cells.
For families that choose to bank cord blood, the American Academy of Pediatrics (AAP) recommends public cord blood banking. Estimates vary, but the chances of a child having a stem cell transplant, with either bone marrow or cord blood, are 1 in 217 over a lifetime. Although the AAP states cord blood has been used to treat certain diseases successfully, there isn’t strong evidence to support cord blood banking. If a family does decide on cord blood banking, the AAP recommends public cord blood banking (instead of private) to cut down on costs. If you donate cord blood and your child eventually needs it, you can get it back as long as it hasn’t been discarded or used.
Americord offers parents the ability to collect stem cells from the placenta and umbilical cord soon after the child’s birth. These stem cells, obtained from cord blood, cord tissue and placenta tissue, can be used to help treat genetic diseases and other threats to the baby’s life. Placenta tissue stem cells can also be used to benefit the mother.
After injections with their own umbilical cord blood, 63 children with cerebral palsy improved on motor skills, on average. And a clinical trial to see whether cord blood transplants improve symptoms of children with autism spectrum disorder should wrap up in the summer of 2018, says pediatric researcher and clinician Joanne Kurtzberg of Duke University, who helped establish a not-for-profit umbilical cord bank in North Carolina. (A small but optimistic pilot study has already been completed.)
Physicians or other professionals who recruit pregnant women and their families for for-profit placental cord blood stem cell banking should disclose any financial interest or other potential conflict of interest they have in the procedure to their patients.
In a number of genetic, hematologic, immunologic, metabolic, and oncologic disorders, reconstitution of bone marrow (transplantation) can be a potentially life-saving procedure.1–16 Allogeneic (related or unrelated) or autologous (self) bone marrow or peripheral blood stem cells are the usual sources of hematopoietic progenitor cells to achieve this goal. If autologous stem cells are not available or cannot be used, the best option for successful reconstitution therapy is to secure stem cells from an HLA-matched sibling.1,3,11 Close matching confers a higher probability of successful engraftment and minimizes the risk of potentially fatal graft-versus-host disease. Unfortunately, there is only a 25% chance for identifying a full HLA match in a sibling donor.17,18
The stem cells obtained from umbilical cord blood are also less likely than bone marrow stem cells to be rejected in transplants. Considered to be immunologically immature, umbilical cord blood stem cells produce significantly fewer natural killer cells, creating a substantial decrease in rejection. Consequently, cord blood stem cells require less rigorous antigen tissue matching for transplants than bone marrow stem cells (Sullivan, 2008). Research indicates that a mismatch of up to two antigen sites still provides successful clinical outcomes (Ballen, 2006; Fox et al., 2007). In fact, researchers report that the rate of rejection for cord blood stem cell transplants is half the rate of rejection for bone marrow transplants (Ballen et al., 2001). When compared directly in cases of mismatched antigens, there was clearly less rejection in transplants involving cord blood stem cells than bone marrow stem cells (Moise, 2005).
Maschan AA, Trakhtman PE, Balashov DN, et al. Fludarabine, low-dose busulfan and antithymocyte globulin as conditioning for Fanconi anemia patients receiving bone marrow transplantation from HLA-compatible related donors. Bone Marrow Transplant.2004;34 :305– 307
Wall DA, Carter SL, Kernan NA, et al. Busulfan/melphalan/antithymocyte globulin followed by unrelated donor cord blood transplantation for treatment of infant leukemia and leukemia in young children: the Cord Blood Transplantation study (COBLT) experience. Biol Blood Marrow Transplant.2005;11 :637– 646
Jaing TH, Hung IJ, Yang CP, Chen SH, Sun CF, Chow R. Rapid and complete donor chimerism after unrelated mismatched cord blood transplantation in 5 children with beta-thalassemia major. Biol Blood Marrow Transplant.2005;11 :349– 353
Your child may never need it. Stem cell-rich cord blood can be used to treat a range of diseases, but Frances Verter, Ph.D., founder and director of Parent’s Guide to Cord Blood Foundation, estimates that there’s only a 1 in 217 chance that your child will ever need a stem cell transplant with cord blood (or bone marrow). This is particularly true if the child doesn’t have a family history of diseases such as leukemia, lymphoma, or sickle cell anemia. Although the American Academy of Pediatrics (AAP) states cord blood has been used to treat certain diseases successfully, there isn’t strong evidence to support cord blood banking. If a family does choose to bank cord blood, the AAP recommends public cord blood banking (instead of private) to cut down on expenditures.
Banking a baby’s blood and stem cells in a cord blood bank is a type of insurance. Ideally, you would not need to access your baby’s stem cells in order to address a medical concern. However, using a cord blood bank can provide peace of mind in knowing that you have a valuable resource if you need it.
Cord blood banking takes blood from the umbilical cord at the time of birth, and donates it to a public blood bank, or stores it in a private one. Since this blood is so rich in stem cells, which have the potential to become any human cell, it could someday be used as a treatment for the child or their family members.
4. If your family, especially your children, are of mixed ethnic background, it may be impossible to find an adult bone marrow donor who is a perfect match. In that event, cord blood from even a partially matched sibling would be invaluable if a stem cell transplant is necessary.
With umbilical cord blood harvesting, the harvested cord blood does not come from the newborn baby itself; instead, the cord blood is harvested from the blood that remains in the umbilical cord after birth. Umbilical cord blood is never harvested from either mother or child, but only from the unused blood in the umbilical cord, which would otherwise be discarded waste. The harvesting procedure takes only a few minutes and there is zero danger to either the parent or the baby.
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We have 12- and 24-month in-house payment plans to spread the initial cost out over time. They require no credit check and begin with little money down. Starting at approximately $2.50 a day, you can help safeguard your baby’s future. After the term of the payment plan, you are then only responsible for the annual storage fee, which begins at $150.
Americord offers parents the ability to save stem cells from the umbilical cord and placenta after giving birth. This blood banking service uses new technology to ensure that children can receive treatment for genetic diseases. Find out more
The main disadvantage of cord blood transplants is that they take at least a week longer to “engraft”, which means repopulate the patient’s blood supply so that cell counts reach minimum acceptable levels. The longer engraftment time is a risk because it leaves the patient vulnerable to a fatal infection for a longer time.
Some brochures advertising private cord blood banking show children with cerebral palsy, a neurological disorder, who were treated with their own stem cells. In the case of Cord Blood Registry, the company lists all stem cell transplants conducted at Duke University. In a list of individuals treated in their “stem cell therapy data” cerebral palsy is listed. However, transplants were part of an early research study and studies of efficacy are just now underway.
These are diseases for which transplants of blood-forming stem cells (Hematopoietic Stem Cell Transplants, HSCT) are a standard treatment. For some diseases they are the only therapy, and in other diseases they are only employed when front-line therapies have failed or the disease is very aggressive. The lists below include ALL therapies that use blood-forming stem cells, without distinction as to whether the stem cells were extracted from bone marrow, peripheral blood, or cord blood.
Takahashi S, Iseki T, Ooi J, et al. Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies. Blood.2004;104 :3813– 3820
6. Lou Gehrig’s disease. There’s hope that stem cells could help those with Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis, or ALS. The crippling disease comes with a grim prognosis: Many die within three to five years of diagnosis, as their bodies progressively damage muscle-controlling motor neurons in the brain and spinal cord. Scientists are exploring ways to coax stem cells into becoming motor neurons that could be transplanted into ALS patients, restoring their ability to move.
Certain public cord blood banks let you mail in your cord blood. You have to decide before the birth if you want to donate your cord blood. If the hospital where you’re delivering doesn’t accept donations, you can contact a lab that offers a mail-in delivery program. After you’ve passed the lab’s screening process, they’ll send you a kit that you can use to package your blood and mail it in, explains Frances Verter, Ph.D., founder and director of Parent’s Guide to Cord Blood Foundation (parentsguidecordblood.org), a nonprofit dedicated to educating parents about cord blood donation and cord blood therapists.
Families should seriously pursue public banking, donation for research, or private banking instead of discarding their baby’s umbilical cord blood. We aim to be nonpartisan in our dissemination of information, but we believe that discarding your baby’s cord blood is a waste of a once-in-a-lifetime valuable resource.
When all the processing and testing is complete, the cord blood stem cells are frozen in cryogenic nitrogen freezers at -196° C until they are requested for patient therapy. Public banks are required to complete the entire laboratory processing and freeze the cord blood stem cells within 48 hours of collection. This is to insure the highest level of stem cell viability. The accreditation agencies allow family banks a window of 72 hours.
The evolution from pluripotent stem cells down to blood stem cells is currently poorly understood. The latest indication is that, under the right conditions, stem cells in cord blood can be teased to grow into other types of tissue besides blood. This would open up an entirely new realm of potential treatment through the use of stem cells.
Barker JN, Davies SM, DeFor T, Ramsay NK, Weisdorf DJ, Wagner JE. Survival after transplantation of unrelated donor umbilical cord blood is comparable to that of human leukocyte antigen-matched unrelated donor bone marrow: results of a matched-pair analysis. Blood.2001;97 :2957– 2961
Allows you to bank the unique stem cells in placental blood that have shown promise in the growing field of regenerative medicine,6,7,8 placing you and your family in the best position to benefit from ongoing developments in this field.
A well-established history. Public banks are affiliated with nonprofit research institutions or hospitals, so they have a better chance of being managed more soundly. For families without a history of diseases treated by cord blood, such as leukemia and sickle cell anemia, the American Academy of Pediatrics (AAP) recommends that cord blood be donated to public banks. Although the AAP states cord blood has been used to treat certain diseases successfully, there isn’t strong evidence to support cord blood banking. If a family does choose to bank cord blood, the AAP recommends public cord blood banking (instead of private) to cut down on expenditures. Private cord blood banks are affiliated with business corporations, so, like any business, they may go under, says William T. Shearer, M.D., Ph.D., professor of Pediatrics and Immunology at Baylor College of Medicine in Houston.
Lamaze International (2010) does not have a policy specific to umbilical cord blood banking; however, the organization has a specific policy that prohibits advertising of private cord blood banks in any Lamaze media vehicle. This policy was most recently updated and revised in July 2010. In addition, in their book, The Official Lamaze Guide: Giving Birth With Confidence, Lothian and DeVries (2010) reinforce the AAP’s position that expectant families are vulnerable to the marketing strategies of private cord blood banks. The authors go on to say that expectant parents should know that banking umbilical cord blood does not guarantee a cure. Likewise, there is no guarantee that a private umbilical cord blood bank will be able to adequately preserve the cord blood until a time when it is needed. One potential reason for being unable to preserve the cord blood is that the private cord blood bank could go out of business.
Another advantage of using umbilical cord blood stem cells is the decreased risk of the transmission of infectious disease. This particular advantage is partly because umbilical cord blood is almost never contaminated by Epstein-Barr virus or cytomegalovirus (Drew, 2005; Gonzalez-Ryan et al., 2000). Additionally, the processing of cord blood includes collecting data on the history of infection during the mother’s pregnancy. For example, if the pregnant woman has a history of group B streptococcus, active genital herpes, or prolonged rupture of membranes and chorioamnionitis, umbilical cord blood is not saved. Generally, samples of the mother’s blood are also drawn to test for infectious diseases, such as hepatitis, human immunodeficiency virus, and syphilis (Moise, 2005). Furthermore, after the cord blood units are collected, they are screened for disease, and any units that are deemed contaminated or infected are thrown away (Gunning, 2007).