Steven Joffe, MD, MPH, the study's senior author
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.