Cord Blood Banking: Not a Clear-Cut Answer

No sooner do the blue lines show up on a pregnancy test than expectant parents find themselves bombarded with brochures from companies extolling the benefits of umbilical-cord blood banking as a rich source of stem cells to treat future diseases that their son or daughter might develop.

It's all part of a health and medical information overload confronting prospective parents, as they sort through a dizzying array of websites and blogs on the merits of interventions for labor pain, the attributes of natural birthing, how midwives and coaches can help and hundreds of other issues. Some decisions new moms and dads confront should be no-brainers, like breastfeeding, which has significant research backing it up, as well as a slew of professionals to help from pediatricians to lactation consultants. But, like so much of parenting, cord blood banking -- especially with private firms -- is less clear cut.

In the last decade or so, a thriving industry has sprung up so parents can bank cord blood for use by their child or other family member, if necessary, in the future. It's touted as a kind of biological insurance against diseases like leukemia, sickle cell disease and metabolic disorders. For-profit cord blood banks assist with collecting and storing umbilical cord blood for an initial fee, from $1,500 to more than $2,000. They also charge annual storage fees between $90 and $200. It's even become a fashionable registry item, for those friends and family who don't want to give cash, engraved cups, blankets or other more traditional baby shower fare.

The private banks tell families that the sums they pay will provide them peace of mind if they ever need that stored cord blood. So, if families can afford it, why not? Before taking on these costs, consider what some experts involved in cutting-edge stem cell research have to say.

This area of technology is growing at a breath-taking rate, says Dr. Clive Svendsen, director of the Regenerative Medicine Institute at Cedars-Sinai and a leading authority on stem cells. He once was asked if he could see a time when scientists could produce induced pluripotent stem cells -- adult cells that have been genetically reprogrammed to an embryonic stem-like state. His answer then was, "eventually," perhaps decades down the line. But in just months, Svendsen was working in his laboratory with a unique method, which allows scientists to create any kind of stem cell they need from a simple adult skin scraping.

With the alacrity of such innovation in this field, will stem cells from cord blood remain relevant? The answer, unsatisfyingly, is uncertain. There aren't sufficient -- or any -- studies yet to determine if one source of stem cells is more powerful or versatile than another for the wide variety of disease conditions that we would look to stem cell technology to treat.

But this lack of data already has become an argument made by proponents of private banking: Absent facts on the importance of stem cells derived from cord blood and what role they might play in future medicine, isn't banking a small, worthwhile investment? Svendsen, however, notes there's no data on how effectively a cell will function after two-to-four decades on ice; fresh cells, even if not an exact match, might prove a better option.

What Pediatricians Recommend
That's why organizations like the American Academy of Pediatrics have adopted a policy stating there's no strong evidence to recommend routine cord blood banking, especially considering the one in 1,000 to one in 200,000 estimate that a child will need to use his or her own stored cord blood stem cells. It's worth noting the nuance in the academy's stance: it says that while banking as biological insurance for the newly born infant is unwise, it should be considered if a sibling has a condition such as leukemia or a genetic disorder that may be cured with a stem cell transplant, as it is likely that the cord blood from a brother or sister will be a closer match than one from an unrelated donor.

The American Medical Association takes a similar position: it says pregnant women should be made aware of options well before labor as part of prenatal care; the collection procedures must not interfere with standard delivery practices. The AMA also notes that parents could consider public banks as they provide greater utility and greater availability of stem cells to patients from minority populations. The doctors' group says private banking should be considered in families with predisposition to conditions that may be treated with umbilical cord stem cells. It does not recommend private banking for low-risk families.

The pediatricians also like public banks, which are free to donors. Because it's often easier to match ailing patients in need and donors through cord blood than bone marrow, the stored tissues could be beneficial; there are, of course, no guarantees that their child's banked blood would be available to a donor family if the need arose.

A 2009 study in the journal Pediatrics was the first to ask transplant surgeons who use cord blood stem cells how often they tap private banks. Answer? Rarely. That's because the odds already are small that an infant will need its own banked cord blood; in the many instances where blood cell transplants are required, physicians can't tap the patient's supply because they would reintroduce the targeted disease. This is true for genetic diseases and for some patients who develop leukemia, as the same chromosomal abnormalities have been in cord blood as in the leukemic cells that later appear in the child. Sibling donors are often ideal; their availability, of course, diminishes or eliminates the need for banked blood.

Of the thousands of transplants performed by the 93 hematopoietic cell transplant physicians in the U.S. and Canada to treat diseases such as leukemia, only 50 involved privately banked blood; 41 were relatives of the donor; just nine children tapped their own banked cord blood. Of these cases, 36 were planned: recipients were known transplant candidates when the blood first was banked. This underscores the pediatricians' sage advice: bank blood when you know it's likely to be needed by a family member.

• Patients should know the chances are remote that stem cells from their baby's banked blood will be used to treat their child or another family member.
• Patients should be aware it is unknown how long cord blood can be successfully stored.
• Physicians who recruit patients for for-profit banks should disclose any financial interest or potential conflicts of interest.
• Children who develop genetic diseases or inborn metabolism disorders cannot be treated with their own cord blood -- no one can be treated with their cord blood as it would carry the same genetic mutation.

As much as public banks are lauded, they are scarce and parents must make arrangements with them well in advance; even in a big city like Los Angeles, not all large medical centers have a relationship with a public cord blood bank.

The impending arrival of a baby can be stressful and costly for almost any family, even those with considerable means and support. Moms and dads have plenty of tasks they need to tackle because they're proven in concrete, immediate fashion to ensure their baby's health. So given what we know about cord blood banking and all the financial and other challenges that typically confront young families already, my prescription would be caveat emptor.