Live in USA
 |
When an immediate family member has a disease that requires a stem cell
transplant, cord blood from a newborn baby in the family may be the best option.
There is a 25% chance, for example, that cord blood will be a perfect match for
a sibling, because each child shares one of its two HLA genes with each parent.
Occasionally cord blood will be a good match for a parent if, by chance, both
parents share some of the six HLA antigens. The baby's cord blood is less likely
to be a good match for more distant relatives. The inventories of unrelated cord
blood units in public cord blood banks are more likely to provide appropriate
matches for parents and distant relatives, as well as for siblings that do not
match.
Private companies offer to store cord blood for anyone who wants it
done, whether or not there is any medical reason known to do so at the time. The
fee for private storage varies, but averages about $1,500 up front and $100 per
year for storage. When there is no one in the family who needs a transplant,
private storage of a newborn¡¯s cord blood is done for a purely speculative
purpose that some companies have termed "biological insurance."
However,
parents should know that a child's own cord blood (stored at birth), would
rarely be suitable for a transplant today. It could not be used at present to
treat genetic diseases, for example, because the cord blood stem cells carry the
same affected genes and. if transplanted, would confer the same condition to the
recipient. (See the story of Anthony Dones.) In addition, most transplant
physicians would not use a child's own cord blood to treat leukemia. There are
two reasons why the child¡¯s own cord blood is not safe as a transplant source.
First, in most cases of childhood leukemia, cells carrying the leukemic mutation
are already present at birth and can be demonstrated in the cord blood. Thus,
pre-leukemic cells may be given back with the transplant, since there is no
effective way to remove them (purge) today. Second, in a child with leukemia,
the immune system has already failed to prevent leukemia. Since cord blood from
the same child re-establishes the child's own immune system, doctors fear it
would have a poor anti-leukemia effect.
The odds of finding a
suitably-matched, publicly-donated, unrelated cord blood unit are already quite
high and continue to improve as inventories of public cord blood banks grow.
For these and other reasons, the American Academy of Pediatrics (AAP) and many
physicians do not recommend private cord blood banking except as ¡°directed
donations¡± in cases where a family member already has a current need or a very
high potential risk of needing a bone marrow transplant. In all other cases, the
AAP has declared the use of cord blood as "biological insurance" to be "unwise."
The European Group on Ethics in Science and New Technologies (EGE) has also
adopted a position on the ethical aspects of umbilical cord blood banking. The
EGE is of the opinion that "support for public cord blood banks for allogeneic
transplantations should be increased and long term functioning should be
assured." They further stated that "the legitimacy of commercial cord blood
banks for autologous use should be questioned as they sell a service which has
presently no real use regarding therapeutic options."
The Medical Letter On
Drugs and Therapeutics also recently addressed aspects of public and private
cord blood banks, asking the question: "Does Private Banking Make Sense?" After
citing various statistics on the actual uses of privately stored cord blood,
they concluded that: "At the present time, private storage of umbilical cord
blood is unlikely to be worthwhile. Parents should be encouraged to contribute,
when they can, to public cord blood banks instead."
Download