Wednesday, March 17, 2010

Cord blood banking - should you, or shouldn't you?

There was some recent publicity (see here and here) about this issue, provoked by a comment made by Dr Irving Weissman on this issue. As the Director of the Institute of Stem Cell Biology and Regenerative Medicine at Stanford University, his comments are taken seriously. He was quoted as saying that parents were being fleeced by stem cell bankers, and likened them to fraudsters.

The International Society for Stem Cell Research (ISSCR) of which Dr Weissman is also head, was quick to point out that his comments referred to the sale of stem cell therapies rather than the banking of stem cells.

Nevertheless the issue of cord blood banking needs to be clarified.

Cord blood blanking promises to store cells from the cord blood of babies, with a hope that these cells can be used in the treatment of various diseases later on. The idea is that these cells have some potential to differentiate into various mature cells. However it is not usually pointed out that this potential is limited and that these cells cannot form organs or tissues, and cannot replicate adequately to populate an adult body.

It should also be recognized that cord blood cells are banked in two possible ways, as part of a public bank, where the cells can be used by anyone with the appropriate need, or as a private bank where only the donor uses the cells. This latter form of transplant is called an autologous transplant.

While the former has considerable merit, because kids with various diseases can potentially benefit by tapping into this bank, the latter autologous bank has very little to offer.

There are relatively few proven indications for autologous transplants using cord blood, as compared to the heterologous use of cord blood. Furthermore the chance that a child will be able to use his own stored cord blood is very small.

The American Academy of Paediatrics (AAP) produced a policy statement on this issue in 2007. Their position hasn't changed since then. In the document they say: "Because there are no scientific data at the present time to support autologous cord blood banking and given the difficulty of making an accurate estimate of the need for autologous transplantation and the ready availability of allogeneic transplantation, private storage of cord blood as “biological insurance” should be discouraged."

Singapore has a public cord blood bank, called simply the Singapore Cord Blood Bank. They are doing good work and should be supported.

There are two private cord blood banks, Stemcord and Cordlife.

Their claims are that the cord blood can be used to treat an extremely wide range of diseases. Read their claims for yourself : for Stemcord, and for Cordlife.

Read the above for yourself, and take into consideration the AAP's policy statement: "Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use, because most conditions that might be helped by cord blood stem cells already exist in the infant’s cord blood (ie, premalignant changes in stem cells). Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood. Although not standard of care, directed cord blood banking should be encouraged when there is knowledge of a full sibling in the family with a medical condition (malignant or genetic) that could potentially benefit from cord blood transplantation."

One wonders why the Ministry of Health and the Singapore Medical Council does not come down firmer on these unsubstantiated claims by private cord banks.


CM said...

The key issue is potential. As with any potential, the question is whether you want to pay (or can afford to pay) for that potential.
Basically parents have to weigh the probability of the child (or any related family member) using the cord blood, versus money.

I can tell you that it is not an easy decision for parents.

In Singapore, there is a procedure (I believe is free) for transfer of cord blood from the private banks to the public bank. This can be done at any point in time.

The private banks only list current applications and treatable conditions. And I have not met any representatives from the private banks who make unsubstantiated claims. The stored cord blood simply becomes an additional option for medical treatment. Success of the treatment is still dependent on the situation at hand.

In any case, I wish to point out that the public bank is lacking a lot in publicity.

gigamole said...

"I can tell you that it is not an easy decision for parents."

Actually the decision is fairly easy.... other than for the indications recommended by the AAP, I reckon it is a waste of money and effort. The potential you mention is still far from being realized, and the chances that your child will ever get to use those stored cells is very remote.

The websites for the private cord banks actually list numerous diseases the stored cells can be used to treat. That I find to be somewhat dishonest as autologous transplants of this sort are useful for very very limited indications.

" I wish to point out that the public bank is lacking a lot in publicity."

That's absolutely true....they do an awful job at marketing their services.

CM said...

"Actually the decision is fairly easy...."

When friends approach me for advice, I tell them what I know about the technology as well as the perspectives from some doctors I know.
I always tell them about using the public bank as an option.
What I find is that, if they can afford it, they will choose the private bank.

Two friends I know who are initially skeptical (and asked me a lot of questions) ended up choosing the private bank. What is surprising is that they had left me with the impression that they are choosing the public bank.

It is like the Chinese saying "to guard against the one in ten thousand". I don't think you can measure this in terms of money even though the possibility of using the cord blood is remote.

For those who can afford it, I think that statistically, their actions are quite predictable.
Perhaps the decision is quite easy after all.

gigamole said...

I think the motivation between private and public banking is quite quite different.

The latter is really an act of altruism - more like being an organ donor, except your child doesn't really lose anything and suffers no risk. The benefits are more realizable, but are meant for recipients rather than your own child.

The former is really for to purchase an "insurance" against your child developing a treatable disease by autologous transplant. I suppose if you have loads of spare $$$, it will not be a problem. The concern is for parents with limited resources who may be led on an unnecessary guilt trip by those exaggerated claims, should they not be able bank their child's cord blood.

Anonymous said...


As a public cord blood bank supporter, I understand that parents would naturally wish to keep a biological insurance for their children. However, like Gigomole has mentioned, the stem cells in a baby's cord blood would most likely contain the deficient cells and would not be able to help the child if he/she develops an illness later on.

As for the lack of publicity of SCBB, as a non-profit organisation, they are limited by the funds they have. As such, they are unable to publicise like the private cord blood banks.

Also, private and public cord blood banks exist for different reasons and they do not compete against each other for the most number of banked units. More importantly, SCBB wishes to educate the public about cord blood donation.

The final decision lies with the parents.