Mar. 13, 2009 A survey of physicians has found broad support for the position that parents should not bank their newborns' umbilical cord blood in a private blood bank unless another member of the family is at risk for a blood disease that will require a stem cell transplant.
The results of the survey are reported by researchers at Dana-Farber Cancer Institute and their colleagues in the March issue of the journal Pediatrics. Their findings are in general accord with the recommendations of medical organizations that have previously weighed in on the issue.
"Physicians who perform hematopoietic cell transplants in children are well positioned to judge the advisability of private cord blood banking, but their views had never been systematically sought and collected," says the study's senior author, Steven Joffe, MD, MPH, of Dana-Farber. "We found that these physicians have performed relatively few transplants involving privately banked cord blood, and that their position on such banking is generally in line with that of larger medical organizations."
Cord blood is a source of "hematopoietic" (blood forming) cells that can be used in stem cell transplants to treat a range of diseases and disorders. Expanding the collection of cord blood for use in public cord blood banks increases the chance that more people are eligible for transplant, because stem cells culled from cord blood do not have to match a patient's tissue type as closely as donated bone marrow does. Cord blood stored in public banks is made available to unrelated children and adults in need of a stem cell transplant.
Private cord blood banks are for-profit companies that, unlike public banks, store umbilical cord blood for personal or family use. Private cord blood banks typically charge a $1,500 - $2,000 collection fee and an annual $100 - $200 storage fee. Families may decide to store cord blood privately if a relative has, or is at risk for, a disease such as leukemia or aplastic anemia that can be treated by a stem cell transplant. Families without such at-risk members may choose to have the blood stored as a form of "biological insurance," in case the child or another family member unexpectedly develops a disease that can be treated by stem cell transplant.
For the current study, surveys were sent to 152 pediatric hematopoietic cell transplant physicians in the United States and Canada, 93 of whom responded. Questions addressed the number of transplants physicians had performed using privately banked cord blood, their willingness to use such blood in specific situations, and their recommendations to parents regarding private cord blood banking.
The respondents reported that of the thousands of stem cell transplants they had performed, only 50 involved privately banked cord blood. Forty one of those cases were "allogeneic" transplants, in which blood from one individual was used to treat another member of the family. And in 36 of those cases, families already knew of a member who was a candidate for a transplant prior to banking the cord blood. The researchers identified only four or five cases in which cord blood that had been privately banked "just in case" it would someday be needed was actually used to treat a sibling of the donor. They also identified only nine cases in which children whose cord blood had been banked subsequently underwent transplants using their own stem cells (known as autologous transplantation), despite the fact that this is the primary use for which private cord blood banks market their services.
Few of the respondents said they would choose a patient's own cord blood over other alternatives as a source of stem cells for treatment of acute lymphoblastic leukemia. By contrast, more than half said they would use an individual's own cord blood to treat high-risk neuroblastoma, or to treat severe aplastic anemia in the absence of an available sibling donor.
In addition, few would recommend banking of cord blood in families without a member known to have, or be at risk for, a disease that can be treated by transplantation.
"In the absence of a family member known to be a candidate for stem cell transplantation, the chances that privately banked cord blood will be used are quite small," Joffe says. "Families need to balance the high cost of banking such blood against the remote odds of its ever being needed. Pediatricians, family physicians, obstetricians, nurse midwives, and other professionals who work with families should educate parents about the medical community's consensus view on this issue."
The lead author of the study is Ian Thornley, MD, of North Shore Medical Center in Salem, Mass. Co-authors are Mary Eapen, MD, of the Medical College of Wisconsin, Milwaukee; Lillian Sung, MD, PhD, of the Hospital for Sick Children in Toronto; Stephanie Lee, MD, MPH, of the Fred Hutchinson Cancer Research Center, Seattle; and Stella Davies, MD, PhD of Cincinnati Children's Hospital Medical Center.
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