Umbilical Cord Blood Is Banked In Hope That It Can Save Lives Later
Sunday, November 09, 2003 - Page updated at 12:00 A.M.
By Marie McCullough
Knight Ridder Newspapers
AKIRA SUWA / PHILADELPHIA INQUIRER
Donna Altamuro, a technician at the Coriell Institute in Camden, New Jersey, processes umbilical cord blood, which has
several advantages over bone marrow in rebuilding damaged immune systems.
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PHILADELPHIA — In 1988 in Paris, a boy with a life-threatening form of anemia was saved by a new, experimental therapy
— a few ounces of blood from his newborn sister's umbilical cord.
Soon after, facilities for freezing and storing umbilical cord blood began to spring up worldwide.
Today, it's clear the procedure has many advantages over a bone-marrow transplant, the older, more common way of
rebuilding damaged blood and immune systems. But the marketing may have gotten ahead of science.
Cord-blood transplants remain rare and experimental — worldwide, there have been fewer than 2,500. Most are arranged
through public, nonprofit cord-blood storage banks. Yet more and more parents pay commercial storage firms to preserve
newborns' cord blood, attracted by advertising touting a "once in a lifetime" opportunity to buy "biological
insurance."
The chance of needing privately stored cord blood is so remote that the American Academy of Pediatrics has come out
against routine private banking, and several leading transplant physicians have criticized the practice as "unrealistic
and deeply exploitative."
Still, commercial companies now have well over 100,000 cord-blood specimens, at least twice as many as public banks.
Parents who can afford private storage — about $1,000 initially plus $100 a year — consider it a small price for a
sense of security.
Rich in stem cells
Cord blood is medically valuable because, like bone marrow, it is rich in blood stem cells, the precursors of red blood
cells, infection-fighting white blood cells and clot-forming platelets.
A patient whose blood cells have been destroyed by chemotherapy and radiation undergoes a transplant of stem cell-laden
bone marrow or cord blood to resupply his blood and immune systems.
While such transplants are a risky last resort, they have been used successfully to treat about 70 disorders, including
leukemia, lymphoma, aplastic anemia and sickle-cell anemia.
It is crucial that the transplanted cells have immune proteins that closely match the patient's own. If not, the
transplant may be rejected or attack the patient's tissues.
With some diseases in adults, the tissue-matching problem can be avoided by removing some of the patient's own marrow
before chemo, then putting it back to rebuild the blood supply. But self-transplants are ultra-rare with cord blood.
Because many childhood blood disorders are inherited, a child's own cord blood would likely reintroduce the disease.
Frances Verter, a Princeton-trained astrophysicist, lost her first child to leukemia in 1997. Shai Miranda Verter spent
much of her life in hospitals and at one point got a bone-marrow transplant.
In 1998, Verter became pregnant with her second child. She decided to privately store the precious drops of cord blood,
mostly out of fear and grief.
"I knew pediatric cancer ... wasn't supposed to happen again, but I was just very paranoid because a one in 5 million
disease struck my first child," says Verter, who works at NASA's Goddard Space Flight Center in Maryland.
Getting unbiased information on cord-blood banks was tough though. So she assembled an encyclopedic consumer's guide to
cord-blood storage options. Verter maintains it on a Web site, www.parentsguidecordblood.com. Many public and private
banks now link to it.
Verter doesn't make recommendations, though she's a fan of private storage. Her data show private U.S. firms have had
just 71 transplants. Still, she believes someday scientists will learn how to use blood stem cells to regenerate
nerves, muscles and other tissues, making a hoard of perfectly matched stem cells invaluable.
Only the primitive stem cells found in early embryos are known to be able to turn into all types of tissues, and
scientists have barely begun to understand how.
But that's not the impression private banks foster.
At CorCell — an 8-year-old, private bank that has never had any of its 7,000 cord-blood units transplanted — president
Marcia Laleman said: "There is research going on that demonstrates applications in diabetes, lupus, Parkinson's and
other diseases. ... All our advisers say the uses will explode in the next five to 10 years."
That is debatable, but cord blood does have advantages. It is simple to collect and retrieve from storage. A registered
bone-marrow donor must be located and go through a painful procedure when the marrow is needed.
Cord-blood stem cells also multiply more rapidly, are more forgiving of imperfect matches and less likely to attack the
patient's own tissues than marrow stem cells. The problem is that all blood-making stem cells have limitations.
Unlike embryonic stem cells, blood stem cells can't multiply in a culture dish. (At least one research team says it's
overcome this problem, but the jury is out.) Also, scientists can't distinguish stem cells from others in cord blood or
bone marrow; they use white-cell surface proteins to tell whether stem cells are present.
And umbilical cords just don't yield much blood. Public storage banks usually reject a cord-blood specimen smaller than
40 milliliters because it is unlikely to contain enough stem cells to transplant even to a small child. (To ensure an
ample number of stem cells for an adult transplant, bone marrow is preferred.)
But will it ever be used?
The big question — how likely a child is to ever use his own stored cord blood — draws wildly differing estimates. The
most popular seems to be 1 in 10,000.
There is a slightly higher chance of use by a sibling. In fact, the American Academy of Pediatrics says that if a
family already has a child with a disease that may require a transplant, it makes sense to bank the cord blood of
subsequent babies.
However, the chance of a tissue match between two siblings is only about 25 percent.
The chance of a child finding a cord-blood match in the nation's public banks is 75 percent, and even higher if
international databases are searched, said Dennis L. Confer, chief medical officer of the National Marrow Donor
Program, the country's largest network of public blood, bone marrow and cord blood banks.
SOURCE: The Seattle Times, WA - 9 Nov 2003
http://tinyurl.com/ufa0
http://seattletimes.nwsource.com/html/healthscience/2001785722_healthcordblood09.html
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