Expectant parents know the pitch: Save the blood from your baby's umbilical cord. The advice comes from companies offering to collect and store the blood so it will be there "exclusively for future use by your family." Their pamphlets fill OBs' waiting rooms. Their clients and spokespeople turn up regularly on TV. The video clips are at once sensational and heart-rending: a little boy diagnosed with leukemia and now "10 years cancer-free" because his parents paid to save a younger brother's cells. A little girl with cerebral palsy whose parents say she improved miraculously after receiving a transfusion of blood collected during her own delivery. "Put it on your baby registry,"her mother urges. "Strollers can wait. Saving someone's life can't."
Cord blood is already used to treat certain blood cancers like leukemia. That's because the stem cells it contains can take up residence in the bone marrow and give rise to new blood cells. Rare conditions like Niemann-Pick disease and Hurler's syndrome also benefit from cord blood. No one really knows whether it might also help patients with cerebral palsy, brain damage from lack of oxygen, Type 1 diabetes, or heart disease. New research on how to manipulate cord blood and how it might function to help repair brain injuryor tamp down autoimmune attack is some of the most inspiring science around. Does that mean you should you send your baby's blood to a private bank?
Not necessarily. It's unlikely that your family will face the kind of medical emergency that cord blood can address. And if you do, in many cases other treatment options exist. Most importantly, perhaps, cord blood is available through public banks. And often another person's blood can be just as good as for your baby as his would be—in fact,for many cancers and genetic disorders, patients are actually better off with someone else's cells, rather than their own. This is true biological insurance, in which many people join the pool, benefiting those who end up in need. And no matter how exciting the emerging science, that may not change much if and when more treatments become available.
Consider leukemia. Only a subset of leukemia patients need a new set of blood-producing cells. And for those who do, doctors may prefer to try traditional bone-marrow transplants from well-matched family members or other donors. They may also try cord blood from these sources. But they typically won't use a patient's own cells. That's because his cord-blood cells might contain the abnormality that gave rise to the cancer. It's also because cells from other people are more likely to recognize cancerous ones as foreign and attack them. Similar caveats apply for genetic diseases like sickle cell anemia. This may come as a surprise to parents: This mom and dad sued a commercial bank for false advertising and fraud when their son was diagnosed with a genetic bone disease and they discovered, to their surprise, that his preserved cord blood was useless.
Other parents may view one child's blood as insurance for others—and with some reason. Most withdrawals from private banks are for a sibling or other relative, as this analysis by Steve Joffe at Harvard shows.Yet in most of these cases, parents didn't bank the blood just in case: They knew in advance how it might be used. Families with a known disease may also be able to collect and store cord blood for free through the National Marrow Donor Program. Also, if one child needs new blood-forming stem cells and his sibling is a suitable match, doctors can usually perform a bone-marrow transplant, although that procedure is more invasive. Diseases in which a baby's cord blood could turn out to matter for him or a sibling do exist. But when all is said and done, for now at least, private cord banking is probably not cost-effective. The price tag is between $3,000 and $5,000 for collection and about 20 years of storage. Given the low chance that the blood will be needed for a currently recognized treatment, that comes to more than $1 million per year of life saved.
So what about the dazzling future? Cord-blood stem cells are likely to play a bigger role in medicine. Last month, for instance, researchers reported on a tantalizing new method for expanding a population of cord blood cells and using them to treat patients with leukemia. Such patients must undergo high doses of chemotherapy and radiation to prepare for the new cells and tend to suffer awful side effects ranging from high fevers to mouth and throat sores. They are also at high risk of infection until the new cells become established, which can take around four weeks, according to Colleen Delaney of Fred Hutchinson Cancer Research Center. She and her colleagues cut the waiting time for infection-fighting cells in half by expanding the number of cells transplanted. This is early-stage work, still in Phase 1 trials. But if it pans out, it wouldn't make private banking more of a must. Delaney, who was pregnant for some of the research, says she received donations from her OB's other patients. She also used cord blood from public banks.
Preliminary work on brain injury also beckons. Joanne Kurtzberg of Duke is testing cord-blood transfusions for children with cerebral palsy as well as brain damage caused by oxygen deprivation in utero or during delivery. Preclinical work in rabbits and rats suggests that stem cells in cord blood can cross into the brain and help to heal damage—possibly by reducing inflammation, integrating into brain tissue, or prodding this tissue to repair itself, says Kurtzberg. In early stage work with kids, she is now transfusing patients' own privately-banked cells.
One of Kurtzberg's patients, an adorable kid with cerebral palsy named Dallas Hextell, has become a high-profile poster-child for private banking. But patients with cerebral palsy often get better to some degree on their own, says Kurtzberg. So until she conducts a controlled trial, it's hard to say whether Dallas has cord blood to thank or not. Kurtzberg herself runs a large public bank in North Carolina and is piloting a program that would give families access to their own baby's blood for a year before it's released into a general pool. That's because some brain injury becomes apparent in the first year. And for now at least, Kurtzberg's experimental treatments rely on a patient's own cells because these are unlikely to cause an immune reaction. Ultimately, however, she argues that less-closely matched blood, available to all, might also help children with brain injury based on her work.
The same cloud of ifs and maybes applies to cord-blood research for Type 1 diabetes, heart disease, and a host of other illnesses. No one knows which, if any, of these applications will work out; whether umbilical cord blood will be the best stem cell source; or how cord blood stem cells will compare to others—like those created from adult cells—for still-speculative applications. Some stem-cell treatments will probably flourish in the long-run. But it isn't easy to predict which ones or from what cells.
Parents with money to spend may decide that private banking, for all its uncertainty, is worth the gamble. And they may in fact be serving the common good. If their kids do use the blood, in many cases it will be for experimental therapies like Kurtzberg's—in which case they're paying cash and assuming risk (always part of research) so that all of us can learn whether speculative treatments have merit. Still, moms and dads who donate to a public bank, where the cells are more likely to be used, are probably doing the greatest public service. Most cord blood is thrown in the trash, after all. So why not avoid the waste and recycle?