Cord Blood Redux

A few weeks ago I posted about the increasingly popular practice of storing infant cord blood. I have always had my suspicions about the necessity for this, balanced by my fear that any day now one of my sons will get sick and I'll regret not saving some of their stem cells.

I'm feeling a little better after reading this Los Angeles Times article. It had information I'd not heard on the actual demand for cord blood:

The current uses of the stored stem cells are limited, and the private banks have little to show for their work so far.

The three largest cord blood businesses in the United States have collected more than 230,000 samples, generating at least $300 million in revenue from anxious parents. Just a few dozen cord blood samples have been used, primarily for children with leukemia who could have been treated with equally effective alternatives.

At Family Cord Blood Services, just one sample has been used out of the more than 9,000 collected over the last eight years. The child died.

"This is purely a commercial business," said Dr. Eliane Gluckman, a French hematologist who performed the world's first successful cord blood transplant in 1988. It is "just for profit and not for benefit."

And guess what? There's an alternative. Public cord blood banks.

These banks are typically nonprofit. They don't charge parents for harvesting or storing the cells. The public banks resemble blood banks, stockpiling donated cord blood and offering it to anybody in need of a transplant. The banks cover their costs by charging about $20,000 for each sample. As part of an accepted medical procedure, the blood is usually covered by insurance.

Because cord blood can be used with a lower degree of genetic matching than bone marrow transplants, it is ideal for transplants from unrelated donors.

In May, Congress voted 431-1 to spend $79 million to make searching easier by linking public cord blood banks in a national network.

There are about a dozen public banks scattered across the United States. Worldwide, such banks have provided cells for more than 5,000 cord blood transplants.

In other words, more people benefit -- including the child whose blood is collected -- by having a public storehouse of blood from which to draw possible matches. If the child ends up needing stem cells, she can access thousands of donated samples instead of just her own privately stored collection. In the meantime, a nation of people have access to her blood as well as others'; even if she doesn't need to access her cord blood in the course of her lifetime, someone else who needs to may do so under the public system.

Interestingly, the article quotes several people for whom banking cord blood was more akin to getting a Silver Cross pram than an act of protection and preservation.

For Clayton Frech and his wife, a movie actress, banking cord blood for their new son was as essential as buying an infant car seat.

"It's a pretty common and accepted practice in the circles we run in," said Frech, who runs a party-supply business in Los Angeles.

"People don't know exactly what we'll need this for," he said. "It seems better to play it safe and conservative and have some of these cells in storage."

A similar article ran earlier this week in the San Francisco Chronicle. The most interesting thing I learned from it was this:

But what generally isn't clear from the private banks' ubiquitous marketing materials to pregnant women -- in magazines, maternity stores, doctors' offices, direct mail and on the Internet -- is that genetic diseases, such as sickle cell anemia, can't be treated with a child's own cord blood because it already contains the disease.

Many transplant doctors also are hesitant to use a child's own cord blood for nongenetic diseases, such as cancer.

"In children with cancer, I would definitely not use" a child's own cord blood because it was probably contaminated with the disease at birth, said Dr. Joanne Kurtzberg, director of the pediatric blood and marrow transplant program at Duke University Medical Center.

Between these two articles I feel comfortable putting my cord blood conflicts to rest. Which is different from dismissing my fears that a family member will one day need cord blood. As with every parent, the fear of losing a child is part of my marrow. It is good to know that should the situation arise in which we turn to stem cells for a cure, there is a public bank -- egalitarian and anonymous -- that we can turn to.

It is also a good reminder for me to make another deposit to the American Red Cross blood bank, which we're much more likely to need a withdrawl from sooner or later... and which helps many more people on a daily basis than cord blood ever will.