What is the Position of Professional Medical Organizations Towards Private Cord Blood Banking?
The American Academy of Pediatrics (AAP); the Leukemia and Lymphoma Society; The American Society for Blood and Marrow Transplantation and the American Congress of Obstetricians and Gynecologists recommend cord blood donations to public banks and discourage private banking. Cord blood stem cells must be matched between donor and recipient based on the expression of HLA antigens (specialized proteins on the surface of cells that define a patient's unique immune status). There is wide diversity of HLA antigens and the odds of finding a perfect match is challenging, particularly if one is a minority. The chance of finding a match becomes even more challenging if a child is born from two minority parents. Thus, one would think that private banking would make sense, right?
Yet, the premise for private cord blood banking as purported for treating a serious childhood illness has significant shortcomings. First, according to AAP the odds that a child will develop a serious childhood illness (e.g. from acute lymphoblastic leukemia) is 1 out 200,000. Second, even if a child develop leukemia and requires a stem cell transplantation, pediatric bone marrow transplant centers will likely not use privately banked cord blood because it contains genetic mutations that led to the disease. Pediatric bone marrow transplant centers will only perform an allogeneic stem cell transplant to avoid the risk of re-introducing leukemia. Third, the TNC count varies widely depending on how well the obstetrician collected cord blood and how well a cord blood bank purifies the TNC. The TNC count of private cord blood may be insufficient. Fourth, the number of stem cells (actual CD34+ cells) in cord blood is low (~ 1% of the TNC fraction). Thus, there are insufficient number of stem cells in cord blood once the donor exceeds 90 lbs. according to the AAP. Thus, cord blood has a limited shelf-life of utility when privately stored for personal use.
Also, cord blood CD34+ stem cells pose a limited regenerative medicine solution because they only transform into blood cells. They cannot transform into other specialized cells like heart, brain, liver, insulin-producing cells or lung cells. Thus, private cord blood has limited lifetime utility to treat the chronic disease under the current technology as the child attains adulthood. The only situation for privately stored cord blood endorsed by professional organizations is if a family has a sibling that develops a childhood blood or metabolic disorder. Under these conditions, there is only a 25-30 percent chance that a newborn's cord blood will provide an acceptable HLA-match. Thus, the probability that a sibling will have a blood disorder and satisfy a HLA-match is extremely low.
However, the recommendations offered by professional organizations do not address the situation of personalized induced pluripotent stem cells (iPSC). These recommendations were made prior to the development of IPSC technology. We believe that parents made the right decision but for the wrong reasons when they chose to privately store cord blood. iPSC technology now offers new opportunities and applications for cord blood.