Ask the doctor...

I am pregnant and recently received some literature from a cord blood bank. They suggested that I store my baby's cord blood in their bank, in case he needs a bone marrow or stem cell transplant in the future. My insurance company won't pay to have the cord blood collected and stored. Is this something worth paying for on my own?

F. Leonard Johnson, MD of Oregon Health Sciences University responds:

The placenta and umbilical cord contain blood stem cells that are being used increasingly in stem cell transplantation. Cord blood transplantation offers an alternative for patients who do not have a stem cell or bone marrow donor in the family, or cannot locate a donor in the National Marrow Donor Program registry of unrelated donors.

Several blood banks and hospitals around the United States now store cord blood for use by anyone requiring a stem cell transplant. Other private companies offer to store cord blood exclusively for the use of the baby from whom the cord blood was obtained or for a member of the family into which the child is born. For fees of approximately $1,500 for the initial storage and $75 per year of storage, these companies claim that storing cord blood for exclusive family use serves as "biological insurance" for the health of the child. Their brochures contain statements such as:

"More than one in ten people may develop one of the severe illnesses that could be treated by cord blood stem cell therapy."

"Cord blood can be used to treat any cancer or genetic disease that is currently treatable by bone marrow transplantation."

"The cord blood can always be used for the child from whom it was obtained."

Based on these claims it may seem attractive to parents to store stem cells for their baby's future use.

These claims, however, are extremely misleading. Cord blood can rarely be used by the child from whom it was obtained. Most diseases treated by bone marrow or stem cell transplantation require stem cells from another normal individual (an allogeneic transplant). This is likely to remain the case for any disease that has a genetic basis such immune system deficiencies, sickle cell disease or thalassemia, genetic metabolic disorders, or bone marrow failure (aplastic anemia) that is not due to an environmental cause. It's debatable whether cord blood stem cells stored at birth would be useful for a child needing a transplant for leukemia later in life. So far the use of a patient's own stem cells in transplants for leukemia (an autologous transplant) has not proven any better than conventional therapy in pediatric studies.

The child might be able to use his own cord blood stem cells if, in the future, he develops a malignant solid tumor such as a lymphoma or sarcoma that has not spread to the bone marrow. However, stem cells can be collected from the peripheral blood at the time such a tumor occurs, and be successfully used in the transplant instead of cord blood stem cells. Thus, saving the baby's cord blood stem cells for this purpose is not worthwhile.

Based on the incidence of various diseases, one can estimate the chances of a child developing a disease that may need treatment by stem cell transplantation. This risk is nothing like one in ten, as some of the cord blood bank literature claims, but less that one in over 300. Thus, for every 200,000 babies born every year, approximately 600 would face the risk of developing a cancer or another potentially fatal disease that might eventually need treatment by stem cell transplantation. Two-thirds of these patients, however, would be cured with conventional therapy and would not require a transplant. Of the remaining 200 patients who might require a transplant, 66 percent would benefit only from an allogeneic transplant, and approximately 70 patients might benefit from an autologous transplant. Thus, at most only 0.04 percent of the cord blood units stored for the baby's exclusive use might actually be used--and this is very likely a gross overestimate.

Alternatively, if the cord blood stem cells were banked for use by any child who needed a stem cell transplant, the chance that those cells would be used productively is much greater. One can make a comparison with current blood banking practices. If blood banks were to store blood only for the exclusive use of the donor or the donor's family, blood transfusion as we now know it, with its enormous potential to save lives, would no longer be available and effective, with obviously catastrophic consequences for many patients. Ideally, if the impact of cord blood transplantation becomes significant, the current national not-for-profit blood banks would be the perfect repository for these units just as they are for other blood products.

Currently there are only two indications to store cord blood for a family's exclusive use: 1) if the family has a child who is afflicted with a disease and may require stem cell transplantation, or 2) if both parents in the family are known to carry the risk of a potentially lethal disease which could be treated by stem cell transplantation, even if they have not yet had an afflicted child. In these cases, plans can be made in advance to store the cord blood, have tissue typing and other relevant testing performed, and then used if necessary. These attempts by for-profit, family-exclusive cord blood banks to convince parents that they can help their children by buying further "biological insurance" is, in a word, nonsense.

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