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Docs weigh in on private cord-blood banking

Consumer Reports News: March 19, 2009 12:28 PM

The promotional pitches started early in my pregnancy, even before all my friends knew I was expecting. There were brochures in the mail, flyers at my doctor's office and ads in pregnancy magazinesall counseling me to privately bank the blood from my newborn's umbilical cord to preserve the valuable stem cells within. Doing so would provide a type of biological insurance, in case my baby or another family member needed a stem-cell transplant or related therapy in the future.

As someone who tends to overplan and prepare (I still have a stash of canned goods from the Y2K panic), this seemed like a no-brainer to me. Stem cells, I knew, are cellular building blocks that can develop into hundreds of other cell types. Scientists think they may hold the key to treatments and even cures for Parkinson's, diabetes and a range of other diseases. And stem-cell transplants are already used to treat some cancers, and immune, and blood disorders. Wouldn't I want my baby to have her own ready supply of perfectly matched stem cells, just in case? Of course. What parent wouldn't?

But when I began reading more about cord-blood banking, I started having second thoughts, especially when I realized what big business private cord-blood storage has become and how expensive these services are: blood-collection fees typically range between $1,500 and $2,000, and storage fees run between $100 and $200 per year. Of course, I'd spend any amount of money to protect my children, but is private banking of cord blood really warranted, considering that much of the stem-cell promise is still more theoretical than practical, and that stem cells can come from other sources, including bone marrow, public cord-blood banks and someday possibly adult cells?

There isn't a clear-cut answer to this question, as much depends on future medical research and breakthroughs. However, a new study gives insight into the usefulness of private banking in the here-and-now.

Researchers surveyed specialists called pediatric hematopoietic cell transplantation (HCT) physicians. These are the doctors who perform transplants of stem cells to treat children with a range of conditions, including leukemia and aplastic anemia. They are the main group who might currently use privately banked cord blood.

Surveys went to 152 doctors in the United States and Canada, and 93 responded. Out of the thousands of stem-cell transplants these doctors had performed, only 50 had involved privately-banked cord blood. Forty-one of these cases were "allogeneic" transplants, in which blood from one individual was used to treat another member of the family. And in 36 of these cases, families already knew of a member who was a candidate for a transplant before banking the blood. The researchers found only a few cases where cord-blood banked "just in case" had been used. They also found only nine "autologous" cases, in which children had transplants using their own stem cells. This, say researchers, is in contrast to the main marketing message of private banks, which promote the idea of children using cells from their own cord blood. (Doctors, in fact, won't use a child's own stem cells for some illnesses, as this could reintroduce the illness into the child's body.)

The researchers also assessed the doctors' views of private cord-blood banking by asking whether they would recommend it for a newborn with one healthy 3-year-old sibling. When the parents in this scenario were of northern European descent, none of the doctors said they would recommend banking. When the parents were of mixed ethnicity (black father and Japanese-American mother), 11 percent said they would recommend banking, presumably because it might be more difficult for the child to find a stem-cell match from other sources.

Although this was a fairly good-sized survey, the researchers can't be certain that their findings are representative of HCT physicians as a whole. However, the findings are in line with the recommendations from the American Academy of Pediatrics and the American Medical Association*. Both organizations advise against private cord-blood banking for most families, as the likelihood of children needing their own banked blood is low. The exception is when there's a family member who has a current or potential need to undergo a stem-cell transplant.

What you need to know. The decision to privately bank cord blood is ultimately a personal one. After reading the medical and marketing literature, my husband and I decided not to bank our daughter's blood, and we've been fine with this decision. But I do have one regret: that we didn't donate to a public cord-blood bank. Donating to these banks is typically free and the benefits to someone in need can be immeasurable. To learn more, visit the National Cord Blood Program and the National Marrow Donor Program.

Sophie Ramsey, patient editor, BMJ Group has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Read our research on stem cell transplants for treating non-Hodgkin's lymphoma and early breast cancer (subscribers only).

*links to PDF

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