The American Academy of Pediatrics (AAP) endorses cord blood banking, but they currently encourage public over private storage because of a belief that a child will probably not benefit from their own cord blood. But recent medical activities are successfully challenging this presumptive theory. There has been a dramatic increase in the use of cord blood for autologous therapy.
Significant Trend in Autologous Therapy
At the 2010 annual meeting of the International Society for Cellular Therapy (ISCT,) Drs. Francis Verter and J.J. Nietfeld compared the rates at which cord blood is being used for the child who banked it (‘autologous’ therapy,) against cord blood given from a donor to a matching patient (‘allogeneic’ therapy). They found that there were more than 200 cases of autologous therapy by the end of 2009, 70% of which occurred in the last two years of that period. This is a significant increase when you consider that, as recently as 2008, a number of medical professional societies had been insisting that the odds of a child using cord blood stored in a family bank were “negligible.”
This rapid rise in autologous therapy can be partially attributed to an increase in the number of patients with some form of brain injury – the most common being Cerebral Palsy (CP) and Hypoxic-Ischemic Encephalopathy (HIE). According to Nietfeld, the statistics show that the cumulative probability of a child receiving an allogeneic stem cell transplant by age 10 is low, only 1 in 5000. Autologous therapy treatments are actually more likely. The U.S. Centers for Disease Control (CDC) discovered that CP is found in 1 in 300 U.S. children from the ages of 5-10. If cord blood therapy proves effective for only 12% of patients with CP, the number of children receiving autologous cord blood therapy for CP alone would be double the total number of allogeneic transplants for all pediatric cancers and blood disorders.
Given these numbers and the conclusion Drs. Verter and Nietfeld have made about autologous therapy eventually surpassing allogeneic therapy, it’s only a matter of time before the AAP considers a revised policy statement endorsing private cord blood banking for autologous cord blood stem cell therapies.
Private Cord Blood Banking Makes Sense
The benefits of private banking of cord blood and newborn stem cells for future medical treatments are impressive. Private banking provides a better chance of patient matching, with a 100% match for the “banked” child and a 25-50% probability of a match with the patient’s siblings, depending upon disease and acceptable match criteria determined by a doctor. In addition, there is a lower chance of graft-versus-host disease -- a potentially life-threatening condition.
But there is a larger issue that is not being properly addressed by the cord blood banking industry. Traditional cord blood banking – both public and private – does not provide a sufficient quantity of cord blood stem cells. In general, traditional cord blood banking yields stem cell volume sufficient only for a patient weighing up to 65 lbs. Traditional umbilical cord blood yields on average approximately 890 million nucleated cells. A typical cancer patient receiving a cord blood transplant requires approximately 30 million nucleated cells per 2.2 lbs. of body weight. This means for a typical cord blood collection, that the maximum weight of the patient cannot exceed 65 lbs., according to CDC.
Cord Blood Harvesting Technologies
New techniques for cord blood harvesting have emerged, designed to provide more treatment options to a greater variety of patients. In June, Johns Hopkins graduate students announced the invention of a system that significantly boosts the number of stem cells collected from a newborn’s umbilical cord and placenta, which could allow more patients with leukemia, lymphoma and other blood disorders to be treated with these cells. Without adequate collection methods, 90% of these cells are discarded.
A private firm has developed a proprietary technology that collects stem cells from the placenta and umbilical cord blood, preserving up to 10 times more stem cells than traditional cord blood collection methods. It has the additional advantages of a) using an FDA-approved drug to mobilize stem cells from the placenta tissue, and b) relying on devices designed to enhance the collection process.
As the rapid rise of autologous therapy continues, especially for CP and acute traumatic brain injury, the necessity for private banking will increase. The medical science and technology have kept pace with this trend and will continue to do so. Physicians remain enthusiastic about the potential use of placenta stem cells in the emerging fields of gene therapy and cellular repair.
Dr. Robert Dracker, Executive Medical Director, Americord Registry, is a leading hematologist, transfusion medicine specialist and recognized leader in cord blood and stem cell banking. Dr. Dracker was recently named as a consultant to the Food and Drug Administration’s (FDA) Pediatric Advisory Committee.
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