Common Misconceptions About Cord Blood Banking

Misconception:

"Doctors would never treat the child with his or her own cord blood stem cells because it would contain the disease."

Fact:

There are certain medical conditions that would not use autologous stem cells (one's own stem cells):

• Genetic Diseases: A situation in which a child may not be able to use his or her own cord blood stem cells is in genetic diseases, such as sickle cell anemia. If the child has a genetic disease, the cells are not useful in transplantation or regenerative medicine. The only potential therapy using autologous cells in a child with a genetic disease is called gene therapy - using the stem cells to deliver the corrective genetic elements. Gene therapy is still experimental.
• Certain Cancers: In addition, doctors may not choose autologous stem cells for treatment of certain forms of leukemia in earlier years of life, due to the concern that such an early onset may indicate a genetic component. However, if there is a cancer that occurs later in life, the autologous cord blood stem cells would likely be preferable to autologous adult cells collected during remission from leukemia, where there exists the risk of residual tumor cells, MRD (minimal residual disease) which can cause relapse.

In cases in which autologous stem cells cannot be used, a sibling's cord blood is the next best option, which is one of the key reasons why it is important to bank cord blood for all children in the family.

Autologous Use:
Thousands of autologous stem cell transplants - those using one's own stem cells - are performed every year.

• Autologous transplants are performed for diseases such as: Hodgkin's disease, Non-Hodgkin's lymphoma, myeloma, Ewing's sarcoma, neuroblastoma, multiple sclerosis, rheumatoid arthritis, brain tumors, and other solid tumors.
• Research from the Journal of Clinical Oncology reports that even with early-onset disease (within 12 months of birth), the child's stem cells are viable for use in transplantation. In the study, an autologous stem cell treatment for infants with acute leukemia was just as successful as a sibling transplant

Autologous cord blood stem cells have many advantages as a transplant source, including no risk of graft vs. host disease (a leading cause of death for transplant patients), immediate availability, and low risk of the cells being contaminated by disease.

New treatments with cord blood focus on regenerative medicine - where doctors use stem cells to repair damaged tissues and organs in the body. Cord blood stem cells are showing significant potential to treat conditions that have no cure today - like juvenile diabetes and brain injury. For regenerative medicine applications, the child's own cord blood is required.

With the increasing focus on regenerative medicine, it becomes more likely that a child would use his or her own stem cells in the future. The National Academy of Sciences estimates that as many as 1 in 3 individuals in the U.S. (or 128 million people) could benefit from applications of regenerative medicine.

References:
-Memorial Sloan-Kettering Cancer Center website, accessed 9/10/09.
-Ljungman P, Urbano-Ispizua A, Cavazzana-Calvo M, et al. Allogeneic and autologous transplantation for hematological diseases, solid tumors and immune disorders: definitions and current practice in Europe. Bone Marrow Transplant. 2006;37:439-449.

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Misconception:

"The chances that a family, with no history of cancer or disease, will ever need their banked cord blood are so low that people shouldn't bother doing it."

Fact:

Families save their babies' cord blood stem cells with CBR for peace of mind - viewing it as a type of "biological insurance" - because these stem cells may be lifesaving to their family. Most of CBR's clients have no family history of disease but recognize the current and future value of their newborns' cord blood stem cells as a biological resource for medical treatments.

Family History:
Family history is not a reliable indicator of need because most forms of leukemia (the most common stem cell transplant) are not hereditary, and the causes of many cancers and diseases are unknown. In fact, numerous serious diseases treatable with cord blood are not heredity and occur without warning. Many researchers and doctors believe that cancer is "environmentally triggered" and in some cases, certain types of cancers are growing at alarming rates. Recent reports indicate that one in 630 children will get cancer by age fifteen.

Odds of Use:
Although no one can predict future illness or injury, published estimates of the odds of needing stem cells for current uses in transplant medicine are 1 in 217.

Based on current data, cord blood stem cells should remain useful indefinitely, so your family may be able to use the cells for diseases and injuries that occur decades from now. The fastest growing use of cord blood stem cells for CBR families has been in regenerative medicine for the potential treatment of brain injury and juvenile diabetes.

• Transplant Medicine: In transplant medicine, a patient generally will undergo chemotherapy to treat the underlying disease and then receive an infusion of cord blood stem cells to create a new healthy blood and immune system. Cord blood stem cells have been used to treat nearly 80 serious diseases including leukemia, other cancers, and blood disorders.
• Regenerative Medicine: New treatments with cord blood focus on regenerative medicine, where doctors use stem cells to repair damaged tissues and organs in the body. There is great promise for using stem cells in treatments of brain injury, cerebral palsy, and juvenile diabetes.
  

References:
-Nietfeld JJ, Pasquini MC, Logan BR, Verter F, Horowitz MM. Lifetime probabilities of hematopoietic stem cell
 transplantation in the U.S. Biol Blood Marrow Transplant. Mar 2008;14(3):316-322.
-Linden J, Preti R, Dracker R. New York state guidelines for cord blood banking. Journal of Hematotherapy. 1997;6:535-541.

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Misconception:

"Cord blood is not being used yet in medical treatments."

Fact:

Over the past 20 years, through 15,000 transplants, cord blood stem cells have been proven effective in treating many diseases. In fact, cord blood stem cells have been used to treat nearly 80 serious diseases. In transplant medicine, a patient generally will undergo chemotherapy and then receive an infusion of cord blood stem cells to create a healthy blood and immune system.

Cord blood stem cells are showing significant potential to treat conditions that have no cure today - like juvenile diabetes and brain injury. This new field, called regenerative medicine is researching using your baby's stem cells to help repair or replace cells that have been damaged by disease or injury.

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Misconception:

"Cord blood collection takes important blood away from my baby."

Fact:

Cord blood collection is painless and easy and safe for both the mother and newborn. The cord blood is collected after your baby is born and the umbilical cord has been clamped and cut. The cord blood that is being collected is blood that would routinely be thrown away. Your caregiver will not alter the normal birthing process in any way, except to collect your baby's cord blood. Cord blood collection can take place after a vaginal or cesarean birth and even after the placenta has been delivered.

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Misconception:

"The cord blood stem cells may not remain useful after long-term storage."

Fact:

The New York State Health Department Guidelines for cord blood banking state that umbilical stem cells can be stored indefinitely under liquid nitrogen. The policy states, "There is no evidence at present that cells stored at
-196°C in an undisturbed manner lose either in-vitro determined viability or biologic activity. Therefore, at the current time, no expiration date need be assigned to cord blood stored continuously under liquid nitrogen." All science involving cryogenic storage of cells also indicates that the cells should remain viable indefinitely.

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Misconception:

"Cord blood banking is too expensive for most families."

Fact:

Saving your baby's cord blood stem cells is an important investment in your family's health. Compared to the other ways you already protect your family, such as home or auto insurance, saving your baby's cord blood could offer the most valuable protection of all. Because if you ever need it, the lifesaving potential of cord blood stem cells is priceless.

CBR offers several options to help make cord blood banking affordable for every family:

• Monthly payment plans, including $61 per month for 48 months for cord blood banking
• A Gift Registry to which family and friends can contribute
• Grandparents-to-be gifting of cord blood banking

CBR also offers a Designated Treatment Program, which provides cord blood collection, processing, and storage at no cost to families with a medical need.

So before assuming that cord blood banking is too expensive for your family, learn more about the value of cord blood banking and your options for covering the cost.

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Misconception:

"There is no need to bank my baby's own cord blood because I can retrieve my or someone else's donated sample from a public bank."

Fact:

When you donate for public use, if the sample is eligible and stored, the cord blood is available to any patient who needs a transplant. It is not reserved for your family so you cannot assume that it will be available for your family if ever needed.

• For families to make an informed decision, it is important to understand that not all donated samples are banked. As many as 71% of donations may be rejected by public banks based on family medical history, maternal medical history, collection volume, and examination of the maternal blood sample.
• Only private banking ensures that your baby's cord blood is saved and available for your family if ever needed.

If someone in your family needs a stem cell transplant, the most important consideration is having a successful transplant.

• Stem cells from a relative (preferably a sibling) are generally the best treatment option in transplant situations. For treating cancers and blood disorders, having your own family's cord blood available may have significant advantages, including fewer complications, improved survival, and a better quality of life without the need for continual anti-rejection medications.
• So while public banks may be able to help provide an adequate sample for transplant, it may not be the best or most preferable sample.
• Last, there is no guarantee that a matched sample will be available in a public bank. Many patients are unable to find a donor, especially those who belong to minority ethnic groups that are not adequately represented in public banks.

A public bank typically charges a fee (estimated $25,000 to $35,000) when releasing cord blood to the patient in need, which may not be covered by health insurance.

For regenerative medicine applications, the child's own cord blood is required so storing your baby's cord blood is the only option.

References:
-Transfusion, 2000; 40(1):124
-Gluckman E, Rocha V, Boyer-Chammard A, et al. Outcome of cord blood transplantation from related and unrelated donors. New England Journal of Medicine. 1997;337(6):373-381.
-McGuckin CP, Forraz N. Umbilical cord blood stem cells-an ethical source for regenerative medicine. Med Law. Mar 2008;27(1):147-165.

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Misconception:

"If I bank my baby's cord blood stem cells, I will be taking it away from the public donor banks."

Fact:

Of over four million births every year in the U.S., the majority of the parents will do nothing about their baby's cord blood, and the stem cells will be discarded as medical waste.

Some families will privately bank their babies' cord blood for peace of mind knowing that they have this lifesaving resource for their family.

Other families will be interested in donating to a public bank but may not be able to for several reasons:

• Only certain hospitals are able to collect cord blood donations. It is estimated that more than 90% of families do not have access to a public cord blood bank that accepts donations.
• Based on eligibility requirements for the donor and cord blood donation, many families are unfortunately ineligible for donation for a variety of reasons, including family health history, maternal exposure to viruses, and international travel.
• As many as 71 percent of donations may be rejected by public banks based on family medical history, maternal medical history, collection volume, and examination of the maternal blood sample.

Therefore, the limited cord blood supply in public banks is due to lack of funding to make public donation accessible to more expectant parents and not due to those choosing private banking.

Reference:
-Transfusion, 2000; 40(1):124

New uses for cord blood stem cells are being discovered rapidly; however, banking cord blood does not guarantee that the cells will provide a cure or be applicable for every situation. Ultimate use will be determined by the treating physician. Use in regenerative medicine is still considered experimental.