Umbilical Cord Blood (UCB)

These are the 5 main categories of disease that can be treated with UCBT.

1. Malignancies (Cancer)
2. Bone marrow failure
3. Hemoglobinopaties
4. Immunodeficiencies
5. Inborn errors of metabolism

The success rate for UCBT is not 100%, and at present it is not considerably better than a normal Bone Marrow Transplantation (BMT). There are theoretical reasons why an UCBT should be better than a BMT, but that data at present does not show a considerable difference. Overall the one-year survival for a sibling-matched UCBT is between 75-90%. For unrelated UCBT it is between 40-80%. These numbers are not significantly different from the normal BMT outcomes. Also you must note that this is a one-year survival, not a "cure." Many of the patients who survive at one year will go on to die from complications of their BMT or from relapse of their disease.

This is really the most important thing to understand about UCBT. An auto-transplant means that the cord blood is transplanted back into the patient that it came from. An allo-transplant means that the cord blood is transplanted to a different patient. For virtually all the diseases currently treated with UCBT, there are good reasons why you would rather have an allo-transplant instead of an auto-transplant.

All hemoglobinopaties, immunodeficiencies, and inborn errors of metabolism are genetic disorders. If your child has one of these and requires a BMT, you would get absolutely no benefit be replacing your child's abnormal bone marrow with abnormal cord blood. There is also a strong genetic component to childhood cancer and bone marrow failure. Many studies show that cord blood cells, although not yet cancerous, contain many of the mutations that eventually lead to cancer. Thus, it is not currently recommended to perform an auto-transplant in a patient that has a blood born cancer (leukemia, lymphoma, etc.)

Thus the reasoning goes, if your child has or develops one of the 5 diseases mentioned above, there is a good chance that they will not be able to use the UCB that you banked for them. Instead they will either need a typical BMT from a related donor, or they will need UCB from a different donor (other than themselves).

This is the real debate surrounding the need to save UCB for your child. There is much hype around the potential of stem cells to cure all kinds of disease in the future - especially through gene therapy. I urge caution here. The one study that has been done looking at trying to cure an immunodeficieny by manipulating the genes of UCB and then transplanting back in the child was stopped. It was stopped because although the immunodeficiency was "cured," many of the children went on to get leukemia.

Again, I urge caution in banking UCB for this reason. This may be a possibility "some day," but it is not possible right now. Beware of the companies that try to sell you on this point. I do not (and neither does the American Academy of Pedaitrics) recommend that you pay for a technology that does not exist presently and may never exist. If the day comes that it is possible to accomplish these things, I suspect that UCB will not be the sole source of using this technology - this is just my opinion, though.

The risks of UBC banking, if done properly, are minimal. The risk really depends on the motivation. If you have been persuaded that you need to bank the UCB, so that you child will be able to use it for the future, then you will want to retrieve as much UCB as possible. This may interfere with the normal process of delivery and may ultimatly result in too much blood in the umbilical cord blood and not enough in your child. This can cause your child to be anemic as a newborn and not grow well.

Other than anemia, there are really not any other appreciable risks to your child. If you allow the normal process of delivery to occur and then take whatever is left in the umbilical cord, you avoid the risk of anemia all together. However, you now risk that you did not collect an adequate amount of UCB should you need it in the future. This, however, is really more of a risk to your pocketbook than it is to your child - remember, it is unlikely that your child will every need or use the UCB. However, if you need it for a sibling or donate it to a public bank, the amount of UCB may be insufficient for UCBT.

My suggestion ... always remember the golden rule, "First do no harm." If you want to bank your child's UCB for any reason, make sure you do not do it at the expense of a normal and safe delivery.

The next question surrounding UCB is... will you bank it for child, someone in your family, or donate it to someone else that night need it? If someone in your immediate family needs a donor or if you have a strong family history of something that may require a BMT for treatment, then you should consider banking your child's cord blood. However, remember you are not really banking the UCB for your child but for a different family member who may need a BMT. As mentioned above, if your child needs a BMT, it is unlikely that their own UCB will be appropriate.

The next consideration is donating your child's UCB to a public bank that will match it and use it for someone unrelated who needs a BMT. This would be akin to donating blood at the local blood bank. Instead of giving a pint of potentially life-saving blood though, you will be giving your baby's umbilical cord blood to someone who needs a BMT.

If you donate your child's UCB to a public or private bank, then the UCB will be tested for both infectious and genetic diseases and you will be notified of the results. Some people want to know the results of these types of tests and others do not. My advice, if you are planning to bank your child's UCB, ask exactly what the bank will test for and then do a little research into what the results (both positive and negative) of those tests will mean for you and your child.

Private banking

The cost is variable but the first year including collection, transport, processing and storage will generally run you somewhere between $1000-$2000. Then most companies will charge an annual maintenance fee of between $100-$200.

Click here for a cost comparison of three of the major private banks.

Public banking / Donation

There is no cost to the donor. The public bank absorbs all costs and fees.

Pediatrics: 2007

This is a great review article and "policy statement" from the AAP. It goes into everything in more deatil and has a long list of references if you want to read about any of the specifics.

National Marrow Donor Program

Check out this website if you want more information and UCBT and donating your baby's UCB.

My advice:

1. Bank your baby's cord blood with a private company if you already have a child who has an illness that may benefit from an UCBT.

2. Consider banking your baby's UCB with a public company so that it can be used to potentially save a life. However, make sure you are prepared to deal with the results of any testing they may do.

3. Do not bank your baby's cord blood for possible use in the future.

Here are the official recommendations from the AAP and I agree with them.

1. Parents are encouraged to donate their child's cord blood to a public bank, which might someday help treat someone in need. Most public and private cord blood banks will disclose to parents any abnormal findings in the harvested blood, alerting them to potential issues concerning their child's health.

2. Parents of an older child with a condition that could benefit from transplantation are encouraged to bank their newborn's cord blood in a private cord-blood bank allowing donation to a first-degree relative.

3. Parents are discouraged from banking with a private company as "biological insurance" for later personal or family use because there is currently no scientific evidence to support the benefit of autologous cord blood banking. Estimates of the chance of a child needing his or her own cord blood in the future vary from 1:1000 to 1:200,000.

4. Cord blood should only be collected for banking with an institutional review board-approved protocol and with signed informed consent from a parent. Pertinent donor information should be kept confidential and used only to report important medical information obtained during the cord blood collection, processing, and screening process that is relevant to the safety of the donor and family.

5. If cord blood was collected from a newborn who subsequently developed a genetic, immunologic, or malignant neoplastic disorder, parents should notify the cord blood bank to prevent its use for transplantation.

6. All cord blood units banked for potential use should be tested for infectious diseases and for hereditary hematologic diseases.

7. Pediatricians should remain aware that future cases may define who has a legal duty to notify parents about genetic abnormalities identified during cord blood testing.

8. Cord blood banks should comply with national accreditation standards developed by the Foundation for the Accreditation of Cellular Therapy (FACT), the US Food and Drug Administration (FDA), the Federal Trade Commission, and similar state agencies.

9. Clinicians involved in procurement of cord blood should be aware of cord blood collection, processing, and storage procedures as set forth in the guidelines.

10. Cord blood-banking recruitment practices should consider the possible emotional vulnerability of pregnant women and their families and friends, and efforts should be made to minimize the effect of this vulnerability on cord blood-banking decisions.

11. Clinicians should provide accurate information about the potential benefits and limitations of allogeneic and autologous cord blood banking and transplantation.

12. Cord blood collection should not be performed in complicated deliveries.

13. Clinicians or other professionals who recruit pregnant women and their families for for-profit placental cord blood stem cell banking should disclose any financial interest or other potential conflicts of interest.

14. Underserved minorities should be recruited in public cord blood-banking programs.

It is important for everyone to understand that the purpose of this website is educational - to provide information. It is not a replacement for your doctor and I am not entering into a doctor-patient relationship with any of the readers of these pages or their children. It is my goal that by providing you with easy to understand information based on the latest research you will be empowered to work with your doctor to raise...healthy kids!