Yahoo Lifestyle Storing Cord Blood: A Growing Trend
It’s been your baby’s lifeline since he was about the size of a lentil. Through it he has received all his essential nutrients while growing inside your womb. Then, within minutes of birth, the umbilical cord is clamped, cut and thrown away as biological waste.
Or at least it used to be. Now doctors have cottoned on to the continued life-giving potential of the blood that’s left behind in the umbilical cord and the placenta. This blood is a rich source of stem cells that have the potential to turn into a whole host of other blood and immune cells.
These wonder cells can today be used to treat a range of diseases, including leukaemia and other cancers, immune deficiencies and blood disorders. In the future, they may very well hold the potential to treat other conditions, too, from diabetes to brain injury.
“Stem cells are valuable because they can differentiate into cells that form other sorts of tissue,” explains Dr Ted Weaver, the immediate past president of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. “Today’s waste could be tomorrow’s therapeutic tool.”
A GOOD MATCH
Not surprisingly, some parents are now choosing to have their babies’ cord blood stored, in case it can be put to good use. However, participation rates in Australia are among the lowest in the world. According to Associate Professor Mark Kirkland, medical director for Cell Care, one of Australia’s leading private cord-blood banks, “up to 98 per cent of cord blood in this country is going in the bin.”
Parents who do choose to have their bub’s cord blood banked can do so in one of two ways. They can either donate the blood to the public bank network at no charge, so that it can be accessed by any patient in the world who needs it, or they can bank it privately, at a cost, for the exclusive use of their child in the future.
Cord-blood stem cells are similar to those found in bone marrow and can be transplanted to a recipient in the same way. “For children with leukaemia, essentially when other therapies including chemotherapy fail, a transplant with matched stem cells from cord blood or bone marrow, that can reproduce the entire blood and immune system, may be life-saving,” says Dr Robyn Rodwell, director of the public Queensland Cord Blood Bank at The Mater Hospital in Brisbane.
“The great thing about cord blood is that while it must be a suitable match, it doesn't have to be as perfect a match as bone marrow and there are fewer complications following transplant,” she explains. “This is because the stem-cell donor is a newborn baby with an immature immune system.”
Cord blood has other advantages as well. “There is no risk to the mother or baby in collecting the cord blood and the cord blood is readily available as it is stored frozen, ready for release,” Dr Rodwell says. “When looking for a stem-cell donor for kids with life-threatening diseases in need of a transplant, looking for a cord-blood donor upfront is in many cases becoming the preferred option.”
In the case of leukaemia – the most common reason for needing a stem-cell transplant – doctors nearly always prefer to use another baby’s cord blood, because the sick child’s own cells would likely contain the very disease trying to be fought.
“If I saw a child diagnosed with leukaemia who needed a transplant, even if that child had privately banked blood, I’d say let’s find an alternative product, because there’s a better chance it’s free of the disease,” says Dr Karin Tiedemann, transplant physician and medical director of the public BMDI Cord Blood Bank, located at the Royal Children’s Hospital in Melbourne .
LOOKING TO THE FUTURE
There are, however, other disorders where a patient’s own (‘autologous’) stem cells are needed. “A small number of children every year will need treatment for advanced stages › of a solid malignancy, such as neuroblastoma [a tumour that develops from nerve tissue],” says Dr Tiedemann. “Part of the treatment is to give autologous bone marrow or cord blood back to that child after chemotherapy.”
Private banks, then, often highlight the benefits of autologous stem-cell transplants. But apart from this current-day application of stem cells, it’s their potential future uses that are the main draw of private cord-blood banks, and the role of stem cells in the regenerative-medicine therapies of the future is certainly the focus of a lot of ongoing research.
Associate Professor Kirkland says that at a recent symposium on cord blood in San Francisco in the US, an entire day was set aside for discussing emerging treatments using cord blood. “There are about 20 trials currently under way around the world, ” he says. “They are looking at health issues including cerebral palsy, deafness and type-1 diabetes, and most of these trials are using the person’s own cord blood.”
In the instance of the diabetes trial, Associate Professor Kirkland says that the treatment is about restoring a person’s immune tolerance (since, in type-1 diabetes, the body’s immune system attacks it’s own insulin-producing cells). This is something that is simply not achievable using cells from another person. But while these clinical trials are throwing up tantalising possibilities, it’s important to note there is no published evidence yet to say these medical applications are going to be workable, straight away at least.
“Autologous stem cells will no doubt become more useful, but when? In 10, 20, 50 years’ time? It’s a rapidly emerging area of clinical medicine, but we can only talk about the current level of knowledge and what we know now,” says Dr Weaver.
Associate Professor Kirkland’s outlook is slightly different. “There are a whole pile of potential future uses that will require your own cord blood. That’s why, to a fair extent, most parents who are using private cord-blood banks are taking out an ‘insurance policy’ that the science will develop over the next five to 10 years,” he says.
“We cannot say to parents that there is no potential for use of cord blood banked privately,” concludes Dr Tiedemann. “Many people have been treated with autologous [cells]. However, it’s important to remember that stems cells don’t necessarily have to come from cord blood.” Indeed, stem cells can be harvested from other parts of the patient’s body – so you’ve not ‘missed out’, so to speak, if you haven’t banked your child’s cord blood.
GETTING YOUR OWN BACK
At present, the only way of completely guaranteeing access to your child’s own stored cord-blood is to use a private bank. This is because with the public cord-blood bank, when the cord blood is needed for an approved medical procedure, a match is found via the public bank register and the blood is released.
If, however, your child requires cord-blood stem cells and his donation still remains in the public bank system, then it may be possible for his own cells to be used for therapy (provided, of course, he is not suffering from a condition where his own cells are likely to carry the disease).
Similarly, if you’ve donated one child’s cord blood to the public bank and he has a sibling requiring treatment, there is a chance that, if the blood is still available, can be found and is a match, it can be used by your family. Another option here is ‘directed donation’, which sits somewhere between the public and private banking systems. If you are pregnant and have another child needing treatment, through the hospital you may be able to arrange to have the cord blood collected for your family’s use.
MAKING THE DECISION
There are currently over 23,900 cord-blood units available in public banks within Australia and about half a million around the world. The vast majority of Australians in need of a transplant can find suitably matched cord blood from the public bank, even if it comes from overseas. If you’d like to add to this network and save someone’s life in the here and now, public banking may be the way to go.
If you’re excited by the prospect of what science may yield in the future and cost is no barrier, then privately banking your child’s cord blood could be the option for you.
COLLECTION AND COSTS
There are several key differences between the public and private cord-blood banks, but two major distinctions are in cost and availability.
The public banks are operated by AusCord, which has a presence in Queensland, Victoria New South Wales and the Northern Territory, and only collects donations from a small number of hospitals. You will need to query in advance whether or not your chosen hospital is on the list. The banks don’t operate 24/7, so if you have your baby on the weekend, for instance, you won’t be able to donate. The collection and storage of the cord blood is free. You will need to fill out a questionnaire and give a blood sample, which will be tested for infectious diseases. About six months after bub’s birth you’ll have a second blood test and if the results are clear, the blood will be ready for use.
The private banks will collect cord blood from the majority of hospitals around Australia, 24 hours a day, seven days a week – but this comes at a cost. According to Cell Care, the cost for collection, processing and storage for 18 years is approximately $3300. Think of it like paying for car insurance – it’s an expense for something you hope don’t need to use, but it’s there if you need it!
For more information on cord-blood banking, visit [Australian Bone Marrow Donor Registry|http://www.abmdr.org.au/] and check out the Australian Stem Cell Centre.
RELATED LINKS:
