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Medical Article Essay

December 21, 1999The Hope, and Hype, of Cord BloodBy DENISE GRADYShould parents pay a blood bank to store the blood from their newborn baby’s umbilicalcord and placenta, in case that child or another family member ever needs it to treat canceror leukemia? Expectant parents are being urged to do so by companies that have sprung up during thepast few years to sell cord-blood banking as a form of biological insurance against suchdreaded diseases. The pitch is based on reports in medical journals, such as a major studypublished last week in the New England Journal of Medicine, showing that cord blood cansometimes be used in place of a bone marrow transplant. Like bone marrow, cord blood is rich in stem cells, which can churn out many differenttypes of cells to rebuild a patient’s blood supply and immune system after high doses ofradiation and chemotherapy. And a patient’s own cord blood, or that from a relative, ismore likely than cord blood from an unrelated donor to be a good tissue match and to beaccepted by the recipient’s body.

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Some experts in bone-marrow transplantation and blood banking frown on the cord-bloodbusiness, arguing that people are being frightened into wasting money on a service theywill probably never need. Moreover, private companies are growing in tandem with publicbanks, and some scientists worry that private banking will limit public access to cordblood. They are concerned because the cord blood in private banks remains the propertyof the donor family and is not available to patients seeking a compatible donor. But the companies say that however remote the possibility that the blood will be needed,people who choose to bank their own cord blood have a right to do so. In most cases theircord blood would be thrown away in the delivery room if they did not pay to bank it.

There are only a few cord-blood banks in the United States, and most hospitals do nothave specially trained staff members to collect the blood. Like bone marrow, cord blood must be matched to the recipient by tests for six inheritedtraits that determine an individual’s tissue type. Cord blood does not have to be asprecisely matched as bone marrow, but still, the closer the match, the better the odds ofsuccess. The weaker the match, the more likely it is that the recipient’s body will reject thetransplant, or the transplant will attack the recipient’s tissues, in a life-threatening reactioncalled graft versus host disease.

The companies that freeze cord blood and bank it point out that a person’s own cordblood is a perfect match, and a sibling’s cord blood a more likely match than a specimenfrom a stranger. And so, the argument goes, the best way to protect an entire family fromthe unthinkable is to save the newborns’ cord blood. Promotional literature for one company, Cord Blood Registry, in San Bruno, Calif. ,emphasizes that people with cancer in the family may have a special interest in cord-bloodbanking, along with those who have the hardest time finding matches, which includesmembers of racial minorities, especially families in which the parents are of different races. According to a spokeswoman, Scoti Kaesshaefer, the company reaches parents-to-be bypromoting itself to doctors, nurses and childbirth educators, and by leaving information athospitals.

Among the promotional materials the company provided to the New YorkTimes were copies of articles from other newspapers suggesting that cancer amongchildren is on the rise. The company also has a Web site and an 800 number with arecorded greeting that instructs callers to have their credit cards ready. The idea of saving one’s own cord blood seems to be catching on. Cord Blood Registry,which describes itself as the largest private cord-blood banking firm in the United States,has stored 10,000 samples during the past three years: 1,500 in 1995, 3,000 in 1996 and6,000 in 1997. The company charges an initial fee of $1,200 to collect a sample and freezeit, and then $95 a year to keep it stored in liquid nitrogen at the blood bank at theUniversity of Arizona. Customers include people with perfectly healthy children, who justwant extra peace of mind, as well as some families who have lost a child to leukemia oranother disease and fear for the health of their other children.

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In its three years of operation, eight customers have retrieved their cord blood for use inmedical treatment, said Kaesshaefer. All eight samples were used for siblings or relatives,she said. By contrast, the largest public-access bank of cord blood, at the New YorkBlood Center in Manhattan, has collected only 8,686 specimens in six years. But nearly800 of those samples have been used to treat patients, many of them children, in theUnited States and overseas. Critics of private cord-blood companies point out that even if a person with banked cordblood does need a transplant later, the stored blood may not be the best choice. Dr.

PabloRubinstein, who directs the cord-blood program at the New York Blood Center, saidthere was a compelling medical argument against using a patient’s own cord blood in somecases. In some young children with leukemia, he said, malignant cells were already presentat birth in the cord blood, and transfusing those cells back into the child later mightcontribute to a relapse. In addition, he said, bone marrow from a donor could help destroydiseased cells, an effect known as graft versus leukemia. A person’s own cord blood mightnot have that effect, and in some cases even a sibling’s might not.

Dr. John Wagner, associate director of bone marrow transplantation at the University ofMinnesota in Minneapolis, said that for a child being treated recently, he deliberatelyrejected cord blood from a sibling in favor of a well-matched unit from an unrelateddonor, hoping to take advantage of its antileukemic effect. Dr. Robertson Parkman, director of bone marrow transplantation at Children’s Hospital inLos Angeles, said he saw no point in banking cord blood for most families. It’s motivatedby fear, he said.

But in families with an ill child who might need a bone-marrow transplant, he said, itmakes sense to collect cord blood from any siblings born later and save it. Medical centerswith transplant programs will often perform that service, he said. So will some of the private companies, without a fee. When a bone-marrow donor couldnot be found for 4-year-old Joshua Kelton, who was suffering from leukemia, his parents,stationed at a military base in Honolulu, conceived another child in the hope that thebaby’s tissues would match Joshua’s. They did, and Cord Blood Registry collected thecord blood at birth, stored it in Arizona for a month, and then, when Joshua was ready forthe procedure, transported it to a medical center at Stanford University.

Joshua wastreated with his infant brother’s cord blood in August, and has been declared free ofleukemia. Right now, he’s 100 percent, his father said in a telephone interview, a normal child, theway he was before this happened. But the Keltons’ experience is hardly representative. That the family was certain it wouldneed the cord blood sets it apart from most families that store the blood.

Wagner is waryof the hard sell of some of the cord-blood companies. My concern is that it be presentedfairly to expectant mothers, who are already fairly vulnerable, he said. I have a lot ofobstetricians and parents calling me and complaining it’s too late, they missed theopportunity. Others call saying, ‘Should I do this?’ It’s hard to answer.

I don’t want to biasthem. We have someone now who takes the calls for me because it got to beoverwhelming.

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Medical Article Essay
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December 21, 1999The Hope, and Hype, of Cord BloodBy DENISE GRADYShould parents pay a blood bank to store the blood from their newborn baby's umbilicalcord and placenta, in case that child or another family member ever needs it to treat canceror leukemia? Expectant parents are being urged to do so by companies that have sprung up during thepast few years to sell cord-blood banking as a form of biological insurance against suchdreaded diseases. The pitch is based on reports in medical journal
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Medical Article Essay
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