Physicians these days are often asked by expectant parents about the pros and cons of umbilical cord blood banking. Is it worth the trouble and expense?

Properly collected and preserved umbilical cord blood (CB) can be a useful alternative source of hematopoietic stem cells (HSC) for patients who don’t have matched related or unrelated stem cell donors for HSC transplantation.

It’s collected under sterile conditions from the umbilical cord at the time of birth, and cryopreserved for later use. CB transplantation (CBT) has been used successfully to treat leukemias, lymphomas, aplastic anemias, myelodysplasias, hemoglobinopathies, immunodeficiencies and some metabolic disorders.

Pros and cons

CB collection is non-invasive, painless and safe. CBT can be scheduled according to patient’s need, without waiting for a suitable donor. Because the lymphocytes in CB are immunologically naïve and the T cells are unmodified, allogenic CBT is less likely than unrelated hematopoietic stem cells to cause graft-vs-host disease. CB stem cells have a higher proliferative potential than bone marrow HSC.

On the other hand, it takes about 50-100 ml of CB to provide sufficient HSC for transplantation to a child or small adult. The major disadvantage of CB is its low volume, which makes it unsuitable for transplantation in most adults and older children.

Cost

There are two types of cord blood banks. Public non-profit banks collect and store CB for transplantation in the general population, or for directed CBT to a family member who has an identified need for it. For example, for an older sibling with leukemia, lymphoma, aplastic anemia, hemoglobinopathy or immunodeficiency, provided that the newborn doesn’t have markers of the same disease. These donations are free, and physicians should encourage them.

Private for-profit banks collect and store the cord blood of those who aren’t high-risk, in case they should ever need autologous CBT in future. This biological insurance is costly. Considering the remote possibility of it ever getting used, the cost isn’t justified. There are 10 private CB banks (6 are accredited) in Canada. The accredited banks charge from $650-$1,125 for initial collection and cryopreservation. There’s also a yearly storage charge, typically in the region of $125-$150.

The odds

The probability of CB ever being used for autologous transplantation is estimated to be from 1:2,500 to 1:200,000. Autologous transplant can be efficacious for those who develop leukemia, lymphoma or some other cancers, but isn’t recommended for patients with genetic marrow failure, immunodeficiency syndromes, hemoglobinopathies or metabolic storage disease. Crucially, the abnormal cells that cause disease later in life may already be present in autologous stored CB.