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A mini-transplant uses lower, less toxic doses of chemotherapy and/or radiation to prepare the patient for an allogeneic transplant. The use of lower doses of anticancer drugs and radiation eliminates some, but not all, of the patient’s bone marrow. It also reduces the number of cancer cells and suppresses the patient’s immune system to prevent rejection of the transplant.
Meet Dylan. Diagnosed with leukemia at just 8 weeks old, he received a life-saving cord blood transplant at 6 months old. Today, Dylan is growing up strong, going to school, travelling with his family and just having fun being a kid!
‡ Payment Plan Disclosures for in-house CBR 6-Month Plan (interest free) – No credit check required. The 6-month plan requires a $10/month administrative fee. The plans may be prepaid in full at any time.
^ a b Ballen, KK; Gluckman, E; Broxmeyer, HE (25 July 2013). “Umbilical cord blood transplantation: the first 25 years and beyond”. Blood. 122 (4): 491–8. doi:10.1182/blood-2013-02-453175. PMC 3952633 . PMID 23673863.
The first cord blood banks were private cord blood banks. In fact, Cryo-Cell is the world’s first private cord blood bank. It wasn’t until later that the government realized the need to preserve cord blood for research and public welfare. As a result, 31 states have adopted a law or have a piece of pending legislation that requires or encourages OBGYNs to educate expectant parents about cord blood banking and many states now have publicly held cord blood banks. As a result, parents have the option of banking their baby’s cord blood privately for the exclusive use of the child and the rest of the family or donating the cord blood to a public bank so that it can be used in research or by any patient who is a match and in need.
Private or family banks store cord blood for autologous use or directed donation for a family member. Private banks charge a yearly fee for storage. Blood stored in a private bank must meet the same standards as blood stored in a public bank. If you have a family member with a disorder that may potentially be treated with stem cells, some private banks will store the cord blood free of charge.
The second question concerns “storing” the newborn’s cord blood for the child’s future use or a family member’s future use. The American Academy of Pediatrics has issued a policy statement saying that, “Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use.” They state: “No accurate estimates exist of the likelihood of children to need their own stored cord blood stem cells in the future. The range of available estimates is from 1 in 1000 to more than 1 in 200000.51 The potential for children needing their own cord blood stem cells for future autologous use is controversial presently.” Read the complete statement here.
However, cord blood transplants also have limitations. Treatment of adults with cord blood typically requires two units of cord blood to treat one adult. Clinical trials using “double cord blood transplantation” for adults have demonstrated outcomes similar to use of other sources of HSCs, such as bone marrow or mobilized peripheral blood. Current studies are being done to expand a single cord blood unit for use in adults. Cord blood can also only be used to treat blood diseases. No therapies for non-blood-related diseases have yet been developed using HSCs from either cord blood or adult bone marrow.
Because identical twins have the same genes, they have the same set of HLA antigens. As a result, the patient’s body will accept a transplant from an identical twin. However, identical twins represent a small number of all births, so syngeneic transplantation is rare.
The stem cells from your baby’s cord blood may also be effective in treating certain diseases or conditions of a parent or sibling. Cord blood stem cells have similar ability to treat disease as bone marrow but with significantly less rejection.
Potential long-term risks include complications of the pretransplant chemotherapy and radiation therapy, such as infertility (the inability to produce children); cataracts (clouding of the lens of the eye, which causes loss of vision); secondary (new) cancers; and damage to the liver, kidneys, lungs, and/or heart.
An additional cost that is borne only by public banks is the “HLA typing” that is used to match donors and patients for transplants. This is an expensive test, running about $75 to $125 per unit. Family banks always defer this test until it is known whether a family member might use the cord blood for therapy.
As a rich source of Hematopoietic Stem Cells (HSCs), cord blood has a number of advantages, including decreased risk of severity of Graft-Versus-Host-Disease (GCHD) and a lower risk of transmissible infectious disease. However, the usefulness of cord blood in stem cell therapy has been limited by the relatively small amount of blood that can be collected using standard procedures. With Cord Blood 2.0™, Americord® is making cord blood banking a lifelong investment with the possibility of treating patients well into adulthood.
Your body has many different types of cells (more than 200 to be more exact) each geared towards specific functions. You have skin cells and blood cells, and you have bone cells and brain cells. All your organs comprise specific cells, too, from kidney cells to heart cells.
The University of Texas Health Science Center at Houston is conducting a pioneering FDA-regulated phase I/II clinical trial to compare the safety and effectiveness of two forms of stem cell therapy in children diagnosed with cerebral palsy. The randomized, double-blinded, placebo-controlled study aims to compare the safety and efficacy of an intravenous infusion of autologous cord blood stem cells to bone marrow stem cells.
Prior to freezing the cells, samples are taken for quality testing. Banks measure the number of cells that are positive for the CD34 marker, a protein that is used to estimate the number of blood-forming stem cells present. Typical cost, $150 to $200 per unit. They also measure the number of nucleated cells, another measure of stem cells, both before and after processing to determine the cell recovery rate. Typical expense, $35 per unit. A portion of the sample is submitted to check that there is no bacterial or fungal contamination. Typical expense, $75 per unit. Public banks will also check the ability of the sample to grow new cells by taking a culture called the CFU assay. Typical expense, $200 to $250 per unit.
Founded in 1992, CBR has stored more than 600,000 cord blood and cord tissue collections from 3,500 hospitals in over 100 countries and partnered with institutions to establish multiple FDA-regulated clinical trials. CBR has helped more than 400 families use their cord blood stem cells for established and experimental medical treatments, more than any other family cord blood bank. CBR’s goal is to expand the potential scope of newborn stem cell therapies that may be available to patients and their families.
Haematopoietic stem cells (HSCs) can make every type of cell in the blood – red cells, white cells and platelets. They are responsible for maintaining blood production throughout our lives. They have been used for many years in bone marrow transplants to treat blood diseases.
CBR was the first family bank accredited by AABB (formerly the American Association of Blood Banks) and the company’s quality standards have been recognized through ISO 9001:2008 certification—the global business standard for quality. The Federal Drug Administration (FDA) has issued cord blood regulations, and the states of California, Illinois, Maryland, New York and New Jersey have mandatory licensing for cord blood banking. The stringent laboratory processes, record keeping, quality control and quality assurance of CBR are designed to meet all federal and state guidelines and regulations.
The immune system has a way to identify foreign cells; it’s what allows the body to defend itself. So although transplants were proving successful after the first in 1956, they were limited to twins because their shared genetic makeup made them 100 percent compatible. This took a turn in 1958, when scientists discovered a protein present on the surface of almost all cells that lets the body know if the cell is one of its own cells or a foreign cell. In 1973, we finally learned enough about these compatibility markers (called human leukocyte antigens or HLAs) to perform the first unrelated bone marrow transplant.
Private (commercial) cord banks will store the donated blood for use by the donor and family members only. They can be expensive. These banks charge a fee for processing and an annual fee for storage.
Cord Blood banking is a confusing topic. Many parents get bombarded with information when searching to see if cord blood banking is right for them. There is information that private cord blood banking companies, like Viacord and Cord Blood Registry, will not tell you, until now.
There are options for relieving the financial burden associated with BMT and PBSCT. A hospital social worker is a valuable resource in planning for these financial needs. Federal government programs and local service organizations may also be able to help.
The proteins stem from three HLA genes, and you inherit one HLA from each parent, or half your HLA markers from your mother and half from your father. This gives siblings a 25 percent chance of being a perfect match, a 50 percent chance of being a partial match and another one-in-four chance of not being a match at all. Unfortunately, about seven out 10 patients who need a transplant don’t have a suitable donor in their family. They can either rely on their own stem cells, isolated before treatment or previously preserved, or try to find a match through a public donor.
Taking time to consider helping another person when you are already busy planning for the birth of your child is greatly appreciated. A gift of cord blood may someday give someone a second chance at life.
Cord blood is also being studied as a substitute for normal blood transfusions in the developing world. More research is necessary prior to the generalized utilization of cord blood transfusion.
The use of hematopoietic stem cells, which can be found in the blood that remains in the vein of the umbilical cord and placenta after birth, is a proven treatment of more than 80 diseases. Mesenchymal stem cells, which can be found in the umbilical cord tissue and can become a host of cells including those found in your nervous system, sensory organs, circulatory tissues, skin, bone, cartilage, and more, are making progress in clinical trials. Some such trials show promise in treating strokes, heart disease, diabetes, autism, cerebral palsy and Alzheimer’s disease.
Banked cord blood is most abundant in white blood cells and stem cells. While a lot of attention is paid to the stem cells, there are approximately 10 times more total nucleated cells (TNCs) than stem cells in any cord blood collection. TNCs are basically white blood cells, or leukocytes; they are the cells of the immune system that protect the body. Despite stem cells comprising one-tenth of most collections, cord blood is still considered a rich source of hematopoietic (he-mah-toe-po-ee-tic) stem cells (HSCs). HSCs are often designated by the marker CD34+. Hematopoietic stem cells can become two categories of cells: myeloid and lymphoid cells. Myeloid cells go on to form your red blood cells, platelets, and other cells of the blood. Lymphoid cells go on to become the B cells and T cells and are the basis for the immune system. Cord blood also contains mesenchymal (meh-sen-ki-mal) stem cells (MSCs), but they are much more abundant in cord tissue, which we will discuss in a minute.
A “tandem transplant” is a type of autologous transplant. This method is being studied in clinical trials for the treatment of several types of cancer, including multiple myeloma and germ cell cancer. During a tandem transplant, a patient receives two sequential courses of high-dose chemotherapy with stem cell transplant. Typically, the two courses are given several weeks to several months apart. Researchers hope that this method can prevent the cancer from recurring (coming back) at a later time.
To save money, public banks will not even process a cord blood donation unless they know in advance that they are going to keep it. When the collection first arrives at the lab, it is passed through a cell counting machine. Only collections that have at least 900 million nucleated cells are kept. As a result, over 60%-80% of cord blood donations are discarded. The public bank must absorb the expense of the collection kit and delivery charges for discarded blood; typically $100 per unit.
Much research is focused on trying to increase the number of HSCs that can be obtained from one cord blood sample by growing and multiplying the cells in the laboratory. This is known as “ex vivo expansion”. Several preliminary clinical trials using this technique are underway. The results so far are mixed: some results suggest that ex vivo expansion reduces the time taken for new blood cells to appear in the body after transplantation; however, adult patients still appear to need blood from two umbilical cords. More research is needed to understand whether there is a real benefit for patients, and this approach has yet to be approved for routine clinical use.
Luckily for expectant parents, cord blood can be easily collected at the baby’s birth via the umbilical cord with no harm to the mother or baby. This is why pregnancy is a great time to plan to collect and bank a baby’s cord blood.
The standard used to identify these cord blood banks was the number of cord blood and cord tissue units stored by each company. The purpose of this analysis is to compare pricing and services among the largest cord blood banks within the U.S., the most mature cord blood banking market in the world. These three industry giants also represent several of the largest cord blood banks worldwide.
The process used to collect cord blood is simple and painless. After the baby is born, the umbilical cord is cut and clamped. Blood is drawn from the cord with a needle that has a bag attached. The process takes about 10 minutes.
The stored blood can’t always be used, even if the person develops a disease later on, because if the disease was caused by a genetic mutation, it would also be in the stem cells. Current research says the stored blood may only be useful for 15 years.
Because of the invasive procedure required to obtain the bone marrow, scientist continued to look for a better source, which eventually lead to the discovery of similar stem cells in cord blood in 1978. Cord blood was used in its first transplant in 1988, and cord blood has since been shown to be more advantageous than other means of acquiring similar stem cells and immune system cells. This is because umbilical cord blood can be considered naïve and immature compared to other sources. Cord blood has not been exposed to disease or environmental pollutants, and it is more accepting of foreign cells. In this case, inexperience makes it stronger.
As cord blood is inter-related to cord blood banking, it is often a catch-all term used for the various cells that are stored. It may be surprising for some parents to learn that stored cord blood contains little of what people think of as “blood,” as the red blood cells (RBCs) can actually be detrimental to a cord blood treatment. (As we’ll discuss later, one of the chief goals of cord blood processing is to greatly reduce the volume of red blood cells in any cord blood collection.)
At present, the odds of undergoing any stem cell transplant by age 70 stands at one in 217, but with the continued advancement of cord blood and related stem and immune cell research, the likelihood of utilizing the preserved cord blood for disease treatment will continue to grow. Read more about cord blood as a regenerative medicine here.
Why should you consider donating the cord blood to a public bank? Simply because, besides bringing a new life into the world, you could be saving an individual whose best chance at life is a stem cell transplant with your baby’s donated cord blood. This can only happen if you donate and if your baby is a close enough match for a patient in need. If you chose to reserve the cord blood for your family, then siblings who have the same parents have a 25% chance of being an exact match.
There is a high likelihood that immediate biological family members could benefit from the baby’s cord tissue stem cells, with parents having a 100% likelihood of being compatible, siblings having a 75% likelihood of being compatible, and grandparents having a 25% likelihood of being compatible.16,50 Another reason why parents today are choosing to bank their baby’s cord tissue for the future.
The procedure for obtaining the cord blood involves clamping the umbilical cord at the time of birth. The small amount of blood remaining in the umbilical cord is drained and taken to a cord blood bank. It is free to donate.
Beyond these blood-related disorders, the therapeutic potential of umbilical cord blood stem cells is unclear. No therapies for non-blood-related diseases have yet been developed using HSCs from either cord blood or adult bone marrow. There have been several reports suggesting that umbilical cord blood contains other types of stem cells that are able to produce cells from other tissues, such as nerve cells. Some other reports claim that umbilical cord blood contains embryonic stem cell-like cells. However, these findings are highly controversial among scientists and are not widely accepted.
When all the processing and testing is complete, the cord blood stem cells are frozen in cryogenic nitrogen freezers at -196° C until they are requested for patient therapy. Public banks are required to complete the entire laboratory processing and freeze the cord blood stem cells within 48 hours of collection. This is to insure the highest level of stem cell viability. The accreditation agencies allow family banks a window of 72 hours.
Both public and family cord blood banks must register with the US Food and Drug Administration (FDA), and since Oct. 2011 public banks also need to apply for an FDA license. All cord blood banks are required by federal law to test the blood of the mother for infectious diseases. At public banks the screening is usually more extensive, similar to the tests performed when you donate blood. The typical expense to a public bank is $150 per unit.
To prevent graft-versus-host disease and help ensure engraftment, the stem cells being transfused need to match the cells of the patient completely or to a certain degree (depending on what is being treated). Cord blood taken from a baby’s umbilical cord is always a perfect match for the baby. In addition, immediate family members are more likely to also be a match for the banked cord blood. Siblings have a 25 percent chance of being a perfect match and a 50 percent chance of being a partial match. Parents, who each provide half the markers used in matching, have a 100% chance of being a partial match. Even aunts, uncles, grandparents and other extended family members have a higher probability of being a match and could possibly benefit from the banked cord blood. Read more reasons why you should bank cord blood.
Current applications for newborn stem cells include treatments for certain cancers and blood, metabolic and immune disorders. Additionally, newborn stem cell preservation has a great potential to benefit the newborn’s immediate family members with stem cell samples preserved in their most pristine state.
Options for Umbilical Cord Blood Banking and Donation—As expectant parents, learn how umbilical cord blood can help others through public donation, family (private) cord blood banking, or directed donation for a biological sibling.
Cord blood banks may be public or commercial. Public cord blood banks accept donations of cord blood and may provide the donated stem cells to another matched individual in their network. In contrast, commercial cord blood banks will store the cord blood for the family, in case it is needed later for the child or another family member.
In the United States, the Food and Drug Administration regulates any facility that stores cord blood; cord blood intended for use in the person from whom it came is not regulated, but cord blood for use in others is regulated as a drug and as a biologic. Several states also have regulations for cord blood banks.