A conversation about medical usefulness, money, and health in individual families | Written by Jan Shultis
Cord blood banking is the practice of preserving the blood found in a baby’s umbilical cord at birth, with the intention that the hematopoietic stem cells found in cord blood could one day be used to create stem cell treatments, should that newborn be diagnosed with a blood-based disease or condition.
Umbilical cord blood stem cells have been used in treatment since the first report of successful transplant in 1989. Cord blood banking became an established practice in hospitals worldwide in 1993, and today many countries also operate public cord blood banks.[1] We know that the blood remaining in the umbilical cord after birth is a rich source of primitive blood cells (hematopoietic blood cells, or “HSCs”), and researchers have an established understanding of how these cells function in the body, how to safely transplant them, and their capabilities and limitations in healing blood-borne diseases, blood cancers, and some defective immune system diseases related to the blood. Since the 1990’s, Americans have
experienced the corresponding installment of commercial cord blood banking companies into hospitals and birthing centers throughout the United States,[2] to the point where many American mothers joke about pressure sales tactics from cord blood banking companies in the birthing suite. Also since the 1990’s, researchers and clinicians have developed and improved other ways of transplanting stem cells from a variety of sources. Comparatively, cord blood stem cell transplants have a much higher rate of failure than other methods.[3] Cord blood stem cell transplants also face greater challenges with engraftment than other stem cell sources (meaning, there are often not enough stem cells in the cord blood to create measurable impact, and can take longer to establish themselves in the recipient’s body and begin producing blood cells, if they ever do. Logistically, problems with engraftment translate to longer hospitals stays and soaring costs for those who choose to pursue such therapies.)
Though the scientific rationale is on the surface worth consideration, the practical question for families is whether cord blood banking is useful to them. In science that exists to serve real people with real needs, any given practice is useful only insofar as people can and do use it. More specifically, we’re looking for accessible biotechnology solutions to felt or anticipated healthcare needs that support the user in crafting the overall life or lifestyle they choose to build. In other words, does it make sense to individual families to bank their baby’s cord blood and pay banking fees for years to maintain that blood bank?
Let’s take a look at each consideration in turn, before answering the most common question we receive from families of older children: that is, “should I keep paying for my baby’s cord blood bank?”
First up, is banking your baby’s cord blood medically useful?
In theory, the answer to whether banking cord blood is medically useful would be the same as the probability of your baby incurring a disease or condition that can be treated with cord blood, cited at less than ½ of 1% (or less than .5%) for the more than 80 disease conditions the cord blood banking industry commonly advertises for, nearly all of which are extremely rare.[4] In reality, however, the percentage is even lower, because a 1:1 correlation between disease manifestation and use assumes a level of success in developing successful treatments from banked cord blood that simply does not exist (more on that in the next question).
A 1:1 correlation also overlooks the fact that in some conditions, such as leukemia, a child’s stored cord blood cannot be used to develop treatment for them because the blood already contains premalignant cells.[5] Statistically, then, no, your child is probably not going to use their cord blood. Physicians, professors, and researchers refer to the chance of using cord blood in terms like “vanishingly small,”[6] and “miniscule,”[7] and the data supports that conclusion.
There are merits to cell therapy for blood-based diseases using umbilical cord blood. Most of the research you will find somewhere like PubMed, where you might go to conduct your own research, demonstrates that autologous (your baby’s own) hematopoietic treatments have a similar safety and efficacy profile to allogeneic (donor). According to the American Association of Pediatrics, the most useful thing that can be done with your baby’s cord blood is donate it to a public bank.[8]
Okay, you might say, but even slim odds are worth protecting against, and many parents would agree with the sentiment. Now for a technical question: if you bank cord blood and your baby needs it, how likely are they to be able to use it?
This is a manufacturing question, and as in many for-profit practices, answers about the efficacy of a given manufacturing process are protected and not readily publicly available. Here’s what we do know: we know that banked cord blood, assuming it is still optimally viable (which means it still has stem cells in it when you thaw it out to try to use it), is typically considered able to create a single stem cell treatment at best. The field of cell therapy has reached at least general consensus that stem cells of any kind are not a “one shot” solution – multiple
administrations of cells are necessary over time (leading-edge translational research, like the kind conducted at Hope Biosciences Research Foundation,
works to answer questions about how many cells, at what periodicity, over what period of time are necessary to support the body’s recovery from specific kinds of diseases, illnesses, and injuries). Thus far, conclusions across cell types and disease conditions favor the conclusion that volume over time is a key component to cell therapy efficacy. What happens if your baby does fall ill, and needs three, or five, or ten, or fifteen cell therapy treatments? Your cord blood bank is essentially useless; even if you have one, other sources or types of cell therapy must be pursued.
That is, as previously stated, assuming the banked cord blood is still optimally viable when you need it. Privately banked cord blood is usually not quality control tested beyond screening for communicable diseases in the parents, and there is no regulatory requirement for quality control testing prior to administration to a patient in need. That means that even if you decide to pursue that single treatment, there is no guarantee of how many cells will be in it, and what your child will receive through it.
In conclusion: we know this is a scary conversation, and it is not meant to frighten, but to inform. There are stem cell banking solutions out there with much higher success rates, quality control testing, and guaranteed viability. Knowing, then, that your baby is overwhelmingly unlikely to ever use the banked cord blood, or to be able to receive a viable treatment from that cord blood, let’s return to the original, common question: should I keep paying for my baby’s banked cord blood?
We can’t tell you how to spend your money. We can tell you that in light of the considerations outlined above, primarily medical usefulness, your dollar has more effective buying power. There is a better path to the shared objective of preserving the best level of health possible for your child.
Whatever you choose, and however you proceed, thank you for talking to us. Thank you for trusting us with intimate and vulnerable questions about your most precious asset – your family. It is a privilege to be here, with you.
Want to talk more about your family? Please call (832) 975-8840 or write to info@hope.bio to continue the conversation. Hope Biosciences, headquartered in Sugar Land, Texas, offers the nation’s only clinical grade stem cell banking services available to both newborns and adults. From your baby’s placenta, mesenchymal stem cells (MSCs) are isolated, expanded, and preserved in a Master Cell Bank that can create more than 1,000 treatments – more than anyone could need in a lifetime, for an array of degenerative diseases and conditions, and for use in cases of traumatic injury. MSCs cultured at Hope Bio have been put to work at more than 35 FDA-authorized clinical trials and expanded access protocols. Bank for actual usage and get peace of mind, guaranteed. Learn more, here.
[1] Gupta, Ashish and John Wagner. “Umbilical Cord Blood Transplants: Current Status and Evolving Therapies.” Fronters in Pediatrics. 2020 (8). Oct 2, 2020. DOI: 10.3389/fped.2020.570282. [2] Access to cord blood banking services, or lack thereof, has sparked intense debate about ethical access and use for patients from varying socio-economic backgrounds, because real conflicts of interest exist between the private cord blood banking industry and public cord blood banks. For more, see Gerdfaramarzi, et al’s “Ethical challenges of cord blood banks: a scoping review” in the Journal of Medicine and Life, June 2022, DOI: 10.25122/jml-2021-0162. [3] Chain, Lydia. “Vast Majority of Life-Saving Cord Blood Sits Unused.” Scientific American. Dec 5, 2014. www.scientificamerican.com/article/vast-majority-of-cord-blood-unused. [4] Waller-Wise, R. “Umbilical Cord Blood: Information for Childbirth Educators.” The Journal of Perinatal Education. Winter 2011; pp54-60. DOI: 10.1891/1058-1243.20.1.54. [5] American Academy of Pediatrics Policy Statement, “Cord Blood Banking for Potential Future Transplantation,” publications.aap.org. [6] Lydia, “Cord Blood Sits Unused,” Scientific American. [7] Zhang, Sarah. “Don’t Pay for Cord-blood Banking.” The Atlantic. October 17, 2022. [8] American Academy of Pediatrics Policy Statement, “Cord Blood Banking for Potential Future Transplantation,” publications.aap.org. To learn more about public cord blood banks, visit bloodstemcell.hrsa.gov
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