What do I need to know about private cord blood storage?
It sounds like a great idea – a new form of medical insurance for your family. But private cord blood banking has sparked fierce debate in the scientific and medical communities.
The cost of private cord blood banking is high. And at this point the chances that your family will need to rely on the blood you've banked are low, unless a disease that can be treated with cord blood runs in your family. On the other hand, advances are being made all the time, and for that reason, advocates say, banking cord blood is a good investment.
According to a study at the University of California, San Francisco, the chances of privately stored umbilical cord blood being therapeutic for a child or immediate family member in the next 20 years probably don't justify the expense of private storage. Researchers estimated the chances at 1 in 2,500 per individual.
"While there are plausible medical advantages of umbilical cord blood stem cells, many of these benefits are primarily theoretical at this point," says Anjali Kaimal, an ob-gyn at Massachusetts General Hospital in Boston and the study's lead researcher. "Expectant parents need to understand the true likelihood of their family benefiting from private cord blood banking in order to make an informed decision about this expensive process."
Only you can decide whether private cord blood banking is right for your family. Here are some things to consider when making your decision:
In most cases, it's better not to treat a child with his own cord blood.
In the case of many childhood cancers and immune deficiencies, a child would not be given his own cord blood. Those stem cells would probably carry the disease genetically, meaning that you'd be reintroducing those defective cells into the child.
In these instances, the best transplant donor would be a matching sibling. (The chance of two siblings being a good match is 25 percent.) For some diseases without a genetic basis, though, a patient's own cells are the best bet because his body won't react against them or reject them.
Researchers hope that cord blood will eventually be used to treat people of all ages with a wide variety of conditions, including diabetes, spinal cord injuries, heart failure, stroke, and neurological disorders like multiple sclerosis. At this point the studies are preliminary but promising.
Your baby's cord blood might not have enough stem cells to treat you or other adults in your family.
One unit of cord blood typically doesn't contain enough stem cells to treat most adults.
According to William Shearer, a professor of pediatrics and immunology at Baylor College of Medicine in Houston and coauthor of the 2007 American Academy of Pediatrics statement on cord blood transplants, researchers have not been able to routinely expand the number of stem cells in a unit of cord blood. But there have been successful transplants involving a combination of two or three cord blood units from unrelated donors – another way of stretching this scarce resource.
Most people have a better chance of finding a stem cell match in the public cord blood system than in their own family.
The chance of an exact tissue match between two siblings is 25 percent, according to Dennis Confer, a hematologist and internist and the chief medical officer for the National Marrow Donor Program (NMDP), a nonprofit organization that facilitates unrelated cord blood and marrow transplants. By contrast, the chance of finding a cord blood match in the nation's public banks is 95 percent, and possibly higher if international databases are searched, he says.
Cord blood isn't the only source of stem cells.
Stem cells are found in circulating blood (also called peripheral blood), bone marrow, hair follicles, fat, baby teeth, and muscle. They're also found in human embryos and fetal tissue, but the use of those cells is controversial. Bone marrow, peripheral blood, and cord blood are the only sources of stem cells currently used for transplants.
Studies show that stem cells from cord blood have certain advantages over other sources of stem cells, but they're not yet the clear winner. "Today, the most common source of stem cells is peripheral blood stem cells," says Mary Halet, director of recruitment and community development at the NMDP. "We're finding about an equal split between bone marrow and cord blood [for other transplants]."
Learn more about the advantages and disadvantages of cord blood and bone marrow.
Unless you select your private bank carefully, the cord blood you bank privately may not be suitable for transplants.
If the day comes when one of your children needs the cord blood you've stored privately, your child's doctor may reject it. The practices and standards of private banks vary, and your sample may not contain enough stem cells for a successful transplant. It's crucial, if you decide to store cord blood privately, that you choose a private cord blood bank carefully.
You may be able to get donated cord blood back.
If you donate your cord blood to a public bank, it's available for the public and any potential matching patient, as well as for research. That means that there's no guarantee that you'll be able to access it if you need it for your family later. But if the need does arise and your donation is still available, you'd have access to it just as anyone else would.
"If the cord blood you donated to a public bank is the optimal one for a transplant for you, it will be available to you unless it has already been used by another person," says Lawrence D. Petz, chief medical officer of StemCyte, a cord blood bank with both a public and a private division. "The likelihood of it having been used is low, since less than 10 percent of publicly banked units are used."
Find out more about donating your baby's cord blood.
Cord blood research is showing promising results.
Studies are under way around the world, and many researchers are optimistic about the future of cord blood. Researchers believe that adult cancer patients may one day benefit from treatment with their own cord blood stem cells that were harvested at birth. The hope is that stem cells will be useful for treating cancers that aren't genetically based.
In light of recent animal experiments, many researchers also believe that cord blood may eventually be used to treat people with conditions as varied as diabetes, spinal cord injuries, heart failure, stroke, and neurological disorders such as multiple sclerosis.
Scientists at the University of South Florida's Center of Excellence for Aging and Brain Repair found that cord blood stem cells helped rats with stroke or spinal cord injuries recover some motor function and helped mice programmed to develop Lou Gehrig's disease develop symptoms more slowly and survive longer. The center is looking at cord blood treatments for diseases like Alzheimer's and Parkinson's as well.
Many experts urge parents to view such studies (especially those conducted on animals) cautiously. It's difficult to predict when, if ever, these treatments will become available for humans.
"Most of these studies have been performed on animals, but the preliminary results have been very encouraging," says Paul Sanberg, executive director of the Center of Excellence for Aging and Brain Repair and vice-chair of the department of neurosurgery and brain repair at the University of South Florida.
Even if you have a family history of certain diseases, public banks may be able to meet your needs.
If your family has a history of leukemia, lymphomas, sickle cell anemia, immune deficiency diseases, aplastic anemia, thalassemia, or other similar conditions, your family's odds of needing a stem cell transplant are higher than the general population's. If you have or plan to have more than one child, you may find the idea of private cord blood storage reassuring.
On the other hand, publicly donated cord blood increases access to transplants. The NMDP says that with cord blood included in its Be the Match Registry, the chances are good that everyone will find a match – with either a cord blood unit or an adult donor.
For help assessing your risk of having a child with one of these diseases, ask your healthcare provider for a referral to a genetic counselor.
If you decide on private storage and you plan to have more than one child, consider banking each child's cord blood.
The more cord blood units you have in storage, the more likely it is that you'll find a perfect match for one of your children. Again, with each sibling there's a 25 percent chance that the stem cells will be a match, and the odds increase significantly with each additional sibling.
If you decide that private cord blood banking is for you, find out how to choose a private cord blood bank. Be sure the doctor or midwife who will deliver your baby is aware of your decision and knows how to harvest cord blood.
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