What we will discuss today

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Umbilical cord blood

banking

It’s Utility?

Dr. Nita Radhakrishnan

Pediatric Hematology Oncology Unit,

Sir Ganga Ram Hospital,

New Delhi

What we will discuss today

• What are stem cells?

• What are the sources of stem cells? • What is stem cell transplant?

• What are the sources of stem cells for stem cell transplant? • How do we decide on stem cell source for transplant? • How do we do umbilical stem cell transplantation? • What is stem cell therapy?

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Uses of stem cells

• Hematopoietic Stem cell transplantation • Allogeneic

• Sibling

• Unrelated bone marrow • Unrelated Cord

• Autologous • Syngeneic

• Stem cell therapy (Regenerative medicine)

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What are the sources of

stem cells?

Cord blood

• A life saving waste product ?

• Collected from the placenta and umbilical cord

after birth of the baby

• Usually goes waste

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Cord blood processing

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Stem cell transplantation

(Allogeneic)

Malignant Disorders •AML

•ALL – very high risk or relapsed •Chronic myeloid leukemia (CML) •Myelodysplastic syndromes •Non-Hodgkin lymphoma

Nonmalignant Disorders

•Aplastic Anemia •Fanconi anemia

•Primary immune deficiencies •Thalassemia major

•Diamond-Blackfan anemia •Sickle cell anemia

•Wiskott-Aldrich Syndrome •Osteopetrosis

•Inborn errors of metabolism •Autoimmune disorders •HLH

Cord blood transplantation

• 1st cord blood transplant performed in 1988 • Since then > 20,000 CBT have been performed

worldwide

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Stem cell therapy

• Stem cells modified through gene transfer or targeted differentiation for treating degenerative disorders like Alzheimer disease, Parkinson disease and ischemic heart disease

• Efficacy is speculative • Most are not even under trial

presently

Cord blood banking: Types

• Private cord blood banking

: expectant parents

store for potential use by self/family.

• Public cord banking

: voluntary donation by

pregnant woman for use by unrelated recipient

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Cord blood banking

• First cord blood bank established in NY in 1992 • Worldwide: 142 public and 25 private cord blood

banks

• India:

• 3 public cord blood bank: Relicord, Jeevan cord,

Stemcyte

• 5 private cord blood bank (7 initially)

Private cord blood banks in

India

• Relicord

• Lifecell (Cryocell International)

• Cryobank (Life force Cryobanks International, Gurgaon) • Cord Life (Cord Life International, Singapore)

• Stemcyte (Taiwan based)

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Cord blood banking

• Under strict guidance of NETCORD,

FACT(Foundation for Accreditation of

Cellular Therapy) or AABB (American

Association of Blood Banks)

• Indian guidelines ICMR

Private blood banking:

What are the actual

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Private cord blood banking

• Cord stem cells for regenerative medicine is still experimental. Will the cord cells be viable by the time this baby develops

diabetes/Alzheimer’s/MI?

• Genetic disorders cannotbe cured by autologous stem cells. Stored cord has the same defect

• Hematological malignancies also cannotbe cured by autologous stem cells

• Benefits are overstated

• Cost involved is huge • Ethical justification?

Private blood banking:

Disadvantages

1. Cost effectiveness?

• US: $1,800 for the initial processing, followed by storage charge of around $100 annually

2. Viability of cells

• Shelf-life or stability of UCB is uncertain

• Evidence of efficacy in the range of 15-18 years

3. Actual need for transplant

• AAP estimate is around 1 in 20,000 (0.04% chance of requiring an autologous stem

cell transplant and 0.07% chance of a sibling requiring an allogeneic stem cell transplant)

• Very few cases of banked cord being actually used later in life for the same person

4. Cell dosage

• Limited cell dose

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Public cord blood banking

• Pros only !

• No cost involved in donation

• Viable alternative

• If at all your child requires it later in life,

good chance of cells still being available

Directed cord blood storage

• Still justified

• Family history of certain diseases: either for

a sibling/ family relative

• Leukemias

• Thalassemia, sickle cell anemias • Immunodeficiencies

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Cord blood banking: Types

• Private cord blood banking: expectant parents

store for potential use by self/family.

• Public cord banking

: voluntary donation by

pregnant woman for use by unrelated recipient

• Directed

cord blood banking

How to counsel expectant parents?

• AAP does not recommend that parents store their infant’s UCB for future use

American Academy of Pediatrics Section on Hematology/ Oncology, American Academy of Pediatrics Section on Allergy/ Immunology, Lubin BH, Shearer WT.

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How to counsel expectant

parents?

• American College of Obstetricians and Gynecologists states that patients who request information on umbilical cord blood banking should be provided with

“balanced and accurate information regarding the

advantages and disadvantages of public vs. private banking and

be informed of the fact that approximately there is a 1 in 2,700 chance that the same unit of UCB will be used for a child or family member”