To save or not to save cord blood. The answer is not so simple. For decades, doctors have put the precious resource to good use, most commonly, to treat patients needing a stem cell or bone marrow transplant.
It can be a lifesaver for families who chose to bank the cells. But others wonder, “Will I ever use it and more importantly will it work?’”
Jesús Torres was experiencing bruising and light headedness. After a month of the mysterious symptoms, tests revealed a devastating diagnosis: acute myeloid leukemia, or AML, an aggressive blood cancer.
Torres had intensive chemotherapy to control the disease in the short-term. For a better long-term prognosis, Loyola Medicine Hematologist-oncologist Dr Patrick Hagen suggested a stem cell transplant – essentially a new immune system.
“Our first choice in that situation is to find another adult who is a genetic match and unfortunately certain ethnic groups, African Americans and Hispanics, which is a big group we serve here at Loyola, having an adult donor in a donor pool is very uncommon,” Hagen said. “(It is) sometimes as low as 10 percent depending on your specific ethnicity.”
For Torres, who is Mexican, the search led the team to cord blood. While his family did not bank cord blood from a newborn, others preserved it and donated it.
“These are family members who have really done a service to the leukemia community by donating newborn child’s stem cells taken from the umbilical cord so this is not taken from the actual baby this is the umbilical cord that would be discarded otherwise,” Hagen said. “We can get away with less similarity between the cord blood and the patient than we could for example a sibling or relative or adult.”
That’s because the newborn stem cells are easily coaxed into new cells.
But there are challenges. Depending on the size of the umbilical cord, the sample may be small, and often patients need a higher volume of cells to help ensure the treatment is successful.
“The more cells, the quicker that bone marrow grows, the less complications that patient can have,” Hagen said.
Fortunately, Torres was able to take part in a clinical trial.
“We take the stem cells, it goes to the lab and they treat it with something that allows the stem cells to divide and grow but not differentiate,” Hagen said.
It’s a process Dr Nadim Mahmud has been perfecting in his UIC lab.
“We can now expand one unit of cord blood to about 8 to 10 units,” Mahmud said.
This bag of cord blood cells will grow to meet the needs of an adult patient like Torres.
“We found a strategy which allows a stem cell to replicate without committing to differentiation,” Mahmud said.
Cord blood cells are most commonly used to treat blood-related disorders and cancers, as well as immune deficiencies. More recently, scientists have begun looking at its efficacy in helping treat brain injury, autism spectrum disorder and cerebral palsy.
Kate Girard is with the private cord blood bank Viacord.
“If those run in your family or if that happens in your family then that is one clinical way to put these cells to work,” she said.
But some families will be disappointed.
WGN News’ Dan Leister lost his daughter to cancer. He and his wife Emily banked her cord blood. But when Meera was diagnosed with brain cancer, the family was told the cells would not be helpful for her disease.
“We spent the time researching it and we have this treatment and it’s going to work it’s going to help her and it just didn’t pan out,” he said.
“Will you ever use them? Every family varies highly,” Girard said.
According to data provided by Viacord, out of 500,000 banked samples, 550 units have been used for transplants, the most common application. Some families have used their stored cells for experimental treatments in a clinical trial – in some cases for the donor child’s own benefit.
“I feel very strongly about families having access to complete and correct information,” Girard said.
But many cords go unused and are disposed of as medical waste. Parents do have choices at the time of birth; give the newborn’s umbilical cord to a public bank, accessed by doctors and researchers or, harvest the cells for your family and store them in a private facility. There is a fee for the initial collection then annual bills for storage. At Viacord, the collection and processing starts at $1900 dollars. The company’s annual storage fee is $175.
“Those are some amazing cells. Put them in a bank and see what science brings,” Girard said.
“It’s interesting what you don’t know that can help others,” Torres said.
For more information
- Loyola Medicine’s stem cell transplant clinical trial,
- Viacord Private Banking
- More on Public Banking
“If you are at a hospital that allows cord blood donation, I would highly encourage it because that donation could potentially save someone’s life,” Hagen said.
More than 35,000 patients have received cord blood as a graft. But even if a family saves cord blood and pays for life, a child or family member in need, facing a cancer diagnosis for example, may not be able to use it. The applications are very specific and do not apply to most cancers.
But research is increasing and that may boost the potential benefits of cord blood.