             |
Charting the Future of Cord Blood TransplantsA federal study is underway to determine how best to collect, store and utilize a precious resource-umbilical cord blood. Like bone marrow, umbilical cord blood contains blood-forming stem cells that can be transplanted into a person with a life-threatening disease. Congress has authorized $1 million for a study by the Institute of Medicine to determine the status of cord blood banking in the U.S. and the most appropriate way to coordinate cord blood resources. Among the issues the study will address are the number of cord blood units needed, the optimal racial/ethnic composition of the units and the best structure for facilitating searches for a cord blood unit. Cord Blood versus Bone Marrow Although bone marrow and cord blood both contain blood-forming stem cells, there are some significant differences. Dr. Pablo Rubenstein, who heads up the world's largest cord blood bank at the New York Blood Center, told an Institute of Medicine committee that using cord blood instead of bone marrow has some distinct advantages. Because the baby from whom the cord blood is collected has not yet developed a mature immune system, the stem cells in umbilical cord blood are less likely than adult bone marrow to cause serious graft-versus-host disease. Graft-versus-host disease occurs when the donor's stem cells unleash an immune system attack on the patient's organs and tissues. It can also take less time to find a suitable cord blood unit than a bone marrow donor. The cord blood units are "on the shelf" and ready to go once the search is initiated and further testing confirms the unit is a match for the patient. By contrast, searching for a bone marrow donor requires a search of a database, contacting potential donors for follow-up testing, harvesting the bone marrow or blood stem cells and delivering it to the patient, all of which can take many weeks or months. However, the number of blood stem cells in each cord blood unit is small. Thus, a cord blood transplant is usually a viable treatment option only for children or small adults. Donating Cord Blood There are currently more than 20 cord blood banks that accept and store umbilical cord blood for public use. In most cases, the banks accept cord blood only from babies delivered at specific hospitals. CryoBanks International in Altamonte Springs, Florida, is one bank that will accept cord blood units from babies delivered anywhere in the U.S. Because collecting and storing cord blood is expensive, Congress has appropriated $9 million to help build up the cord blood inventory in the US. That money will not be released, however, until the Institute of Medicine completes its study. The National Marrow Donor Program (NMDP) -the agency that coordinates searches for stem cell and bone marrow donors-has recently allocated $8 million from its reserves to increase the inventory of cord blood units in its 13 affiliated cord blood banks. Since patients are more likely to find a donor within their own ethnic group, the NMDP is striving to diversify the ethnic composition of the cord blood banks' inventory. The Controversy While there's agreement on the need for more cord blood units, there is sharp disagreement over how a national cord blood program should be structured. Some favor incorporating the national cord blood bank into the infrastructure that has already been created by the National Marrow Donor Program, which currently coordinates donor searches for bone marrow and stem cell donors and cord blood units. Dr. Jeffrey Chell, who heads the NMDP, described for the committee the numerous important advocacy and support services offered by NMDP to patients and their physicians. He urged that federal dollars should be used to build up the inventory of cord blood unit inventory, not to create a duplicative system. The New York Blood Center has proposed that the program be independent of the National Marrow Donor Program. They propose five years of federal support to build up a national inventory of cord blood units, after which it would be turned over to a private corporation to operate. What the Future Holds The Institute of Medicine committee will meet once again this Fall, and is conducting site visits at cord blood banks and other facilities involved in cord blood collection. The committee's recommendations are expected next spring. Anyone interested in following the progress of the study or submitting comments can do so at the Institute of Medicine web site, www.iom.edu. Select Projects on the left-hand side of the home page, and then scroll down to Public Policy-Establishing a National Cord Blood Stem Cell Bank Program. Those without access to the Internet can fax their comments to Judy Estep at 202-334-1329.
|
|
|
||
