What we will discuss today

Transcription

1 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? Pros and cons of umbilical cord stem cell banking How do we counsel parents who enquire about stem cell banking? 1

2 Uses of stem cells Hematopoietic Stem cell transplantation Allogeneic Sibling Unrelated bone marrow Unrelated Cord Autologous Syngeneic Stem cell therapy (Regenerative medicine) What are stem cells? 2

3 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 Rich in hematopoietic stem cells 3

4 Cord blood processing 4

5 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 > 600,000 cord blood units have been stored 5

6 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 Directed cord blood banking 6

7 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) CryoSave Baby Cell 7

8 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 facts? 8

9 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 cannot be cured by autologous stem cells. Stored cord has the same defect Hematological malignancies also cannot be 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 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 Helpful only for child weighing around kgs. Not useful for adults 9

10 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 Role in siblings: chance of HLA match is just 25% 10

11 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. Cord blood banking for potential future transplantation. Pediatrics. 2007;119:

12 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 Currently, private umbilical cord blood banking is cost-effective only for children with a very high likelihood of needing a stem cell transplant Obstetrics & Gynecology:October Volume Issue 4 - pp RCOG guidelines, AAP guidelines 12

13 Private blood banking it at present not allowed in many European countries In USA, the focus on storing is as a potential source for future research and potential use in regenerative medicine. Take home message Current evidence for storing cord blood stem cells for one s private use is limited Research for diseases like diabetes, Alzheimer's, spinal cord injuries, heart failure, stroke are on Benefits are too remote to justify private cord blood storage 13

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