Should you bank your baby's umbilical-cord blood?
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.
Amanda Schaffer is a science and medical columnist for Slate.
Photograph of umbilical cord blood by China Photos/Getty Images.