Medical Article Essay, Research Paper

December 21, 1999

The Hope, and Hype, of Cord Blood

By DENISE GRADY

Should parents pay a blood bank to store the blood from their newborn baby’s umbilical

cord and placenta, in case that child or another family member ever needs it to treat cancer

or leukemia?

Expectant parents are being urged to do so by companies that have sprung up during the

past few years to sell cord-blood banking as a form of “biological insurance” against such

dreaded diseases. The pitch is based on reports in medical journals, such as a major study

published last week in the New England Journal of Medicine, showing that cord blood can

sometimes be used in place of a bone marrow transplant.

Like bone marrow, cord blood is rich in stem cells, which can churn out many different

types of cells to rebuild a patient’s blood supply and immune system after high doses of

radiation and chemotherapy. And a patient’s own cord blood, or that from a relative, is

more likely than cord blood from an unrelated donor to be a good tissue match and to be

accepted by the recipient’s body.

Some experts in bone-marrow transplantation and blood banking frown on the cord-blood

business, arguing that people are being frightened into wasting money on a service they

will probably never need. Moreover, private companies are growing in tandem with public

banks, and some scientists worry that private banking will limit public access to cord

blood. They are concerned because the cord blood in private banks remains the property

of 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 their

cord 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 not

have specially trained staff members to collect the blood.

Like bone marrow, cord blood must be matched to the recipient by tests for six inherited

traits that determine an individual’s tissue type. Cord blood does not have to be as

precisely matched as bone marrow, but still, the closer the match, the better the odds of

success. The weaker the match, the more likely it is that the recipient’s body will reject the

transplant, or the transplant will attack the recipient’s tissues, in a life-threatening reaction

called graft versus host disease.

The companies that freeze cord blood and bank it point out that a person’s own cord

blood is a perfect match, and a sibling’s cord blood a more likely match than a specimen

from a stranger. And so, the argument goes, the best way to protect an entire family from

the 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-blood

banking, along with those who have the hardest time finding matches, which includes

members 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 by

promoting itself to doctors, nurses and childbirth educators, and by leaving information at

hospitals. Among the promotional materials the company provided to the New York

Times were copies of articles from other newspapers suggesting that cancer among

children is on the rise. The company also has a Web site and an 800 number with a

recorded 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 and

6,000 in 1997. The company charges an initial fee of $1,200 to collect a sample and freeze

it, and then $95 a year to keep it stored in liquid nitrogen at the blood bank at the

University of Arizona. Customers include people with perfectly healthy children, who just

want extra peace of mind, as well as some families who have lost a child to leukemia or

another disease and fear for the health of their other children.

In its three years of operation, eight customers have retrieved their cord blood for use in

medical 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 York

Blood Center in Manhattan, has collected only 8,686 specimens in six years. But nearly

800 of those samples have been used to treat patients, many of them children, in the

United States and overseas.

Critics of private cord-blood companies point out that even if a person with banked cord

blood does need a transplant later, the stored blood may not be the best choice. Dr. Pablo

Rubinstein, who directs the cord-blood program at the New York Blood Center, said

there was a compelling medical argument against using a patient’s own cord blood in some

cases. In some young children with leukemia, he said, malignant cells were already present

at birth in the cord blood, and transfusing those cells back into the child later might

contribute to a relapse. In addition, he said, bone marrow from a donor could help destroy

diseased cells, an effect known as graft versus leukemia. A person’s own cord blood might

not 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 of

Minnesota in Minneapolis, said that for a child being treated recently, he deliberately

rejected cord blood from a sibling in favor of a well-matched unit from an unrelated

donor, hoping to take advantage of its antileukemic effect.

Dr. Robertson Parkman, director of bone marrow transplantation at Children’s Hospital in

Los Angeles, said he saw no point in banking cord blood for most families. “It’s motivated

by fear,” he said.

But in families with an ill child who might need a bone-marrow transplant, he said, it

makes sense to collect cord blood from any siblings born later and save it. Medical centers

with transplant programs will often perform that service, he said.

So will some of the private companies, without a fee. When a bone-marrow donor could

not 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 the

baby’s tissues would match Joshua’s. They did, and Cord Blood Registry collected the

cord blood at birth, stored it in Arizona for a month, and then, when Joshua was ready for

the procedure, transported it to a medical center at Stanford University. Joshua was

treated with his infant brother’s cord blood in August, and has been declared free of

leukemia.

“Right now, he’s 100 percent,” his father said in a telephone interview, “a normal child, the

way he was before this happened.”

But the Keltons’ experience is hardly representative. That the family was certain it would

need the cord blood sets it apart from most families that store the blood. Wagner is wary

of the hard sell of some of the cord-blood companies. “My concern is that it be presented

fairly to expectant mothers, who are already fairly vulnerable,” he said. “I have a lot of

obstetricians and parents calling me and complaining it’s too late, they missed the

opportunity. Others call saying, ‘Should I do this?’ It’s hard to answer. I don’t want to bias

them. We have someone now who takes the calls for me because it got to be

overwhelming.”