Umbilical Cord Blood (UCB) Stem Cell - Banking

• Our Role?

• Indications?

• After story?

• Which Bank?

• Cost?

• Hype/Hope?

1886: First use of term - Stem cellsWilliam Sedgwick

Sources of stem cells

Menstrual Blood

Stem cells

Umbilical cord blood

Blood, discarded at birth

with cord & placenta,

can be collected without physical risk to

mother or baby donor

Fantabulous repository of

hematopoitic & mesenchymal

stem cells

Umbilical cord blood

Graft-versus-host disease (GVHD) is

10-folds lower than that seen after

transplantation with HLA-matched bone

marrow

Umbilical cord blood

Cord blood contains sufficient numbers of stem cells capable of reconstituting

the entire hematopoitic system of a child

If you want to store…

Can be used for…

Thalassemia

Sickle cell disorders

Hematological malignancies

Other hematological disorders

Immunodeficiency syndromes

Inborn errors of metabolism

Obstet Gynecol 2005;106:1393–1407

Cord Blood Stem Cells are: Multi-potent stem cells

What happens afterwards…

UCB Banking

PrivatePublic

Private Bank

• Private UCB banks which actually conceptualized after public banks, have gained much popularity!

• First Private Bank: 1992 in USA

• Here the service provider is making money (taken as a fee) in real time and does not have to wait years to break even when units are released for therapy

• Not surprisingly, this business model has enabled family banks to propagate much faster than public banks

Private Bank

• 2001: 17 such banks (11 in the USA, 2 in Canada, one each in

Germany, Hong Kong, Korea and Japan)

• 2015: 215 private UCB banks in 54 countries, plus at least 200

marketing affiliates serving over 70 countries

Ballen KK. Umbilical cord blood donation: public or private? Bone marrow transplantation. 2015 Oct

Cost?

•Probability of being used -1 in 2,700 to 1 in 250,000

Many professional organisations and experts have expressed concerns that

potential donors have insufficient understanding of current accepted indications

for, and the likelihood of, UCB use in a private bank setting.

Furthermore, these banks wrongly advertise and overemphasise unproven possible future indications of these banked stem cells.

Given the substantial cost and low

probability of using the product,

currently private banking of UCB is not

recommended for unidentified possible future use.

Public Bank

• In 1991, Dr Pablo Rubinstein - first unrelated

UCB bank at the New York Blood Centre

• Now > 160 public UCB banks worldwide

• With ∼730,000 UCB units available for public use

Exactly like Blood- Banks

Changing Trend of Cell-Transplant

In 40% cases of UCB transplants - donors and recipients

are living in a different country

Eurocord Report (1998-2007)

• 3327 UCB transplants at 373 transplant centers,

in 43 countries

Transplant Number Percentage

Unrelated 2,965 89.10 %

Related 359 10.81 %

Autologous 3 0.09 %

Private Banks advertise, they don’t publish

Quality

CONCLUSION: Quality parameters of privately banked CBUs are inferior

to those stored in public banks.

The quality of autologous units should be held to the same standards as

those stored in public banks.

Public Bank (INDIA)2008

Private versus Public Banks (Reality check)

• Private Bank

• Expensive

• >99.9% chance that you wont need it

• 50% are not usable

• No therapeutic advantage over autologous PBSC

• Regenerative/stem cell therapy is – Experimental

• Enough – only for a 11 year old/36 kg

• UNETHICAL

Our Role ?• Only 26.5% knew UCB

• More awareness of private cord blood banking compared to public banking.

• One-third of the women in our population had undue expectations from banking of the UCB

• More than half of the pregnant women expected their obstetrician to inform them regarding UCB

In a multicentre study involving five European nations (France, Germany, Italy,

Spain, and the UK) - strong preference for public banking (76.5%) among the

pregnant women. (Katz G.2011Transfusion)

Our Role ?

• Obstetricians should play a more active role in explaining the patients regarding pros and cons of UCB banking.

Obstetricians and others health care professionals delivering antenatal care

should take it as a primary responsibility to increase awareness of umbilical

cord blood donation to develop and expand public banking activities.

Herlihy MM, Delpapa EH. Obstetricians and their role in cord blood banking: promoting a public

model. Obstet Gynecol. 2013

When we deliver one life here; don’t forget we can save ‘one more’

somewhere…

A is a centre where blood gathered as a result of blood donation, stored and preserved for later use in blood transfusion.

1492: First Historical Transfusion AttemptThe blood of three 10-year-old boys was infused by mouth into Pope Innocent VIII as he sank into a coma. The Pope and the boys died.

1667: First Recorded Human Transfusion1st fully documented human blood transfusion was administered in France. Blood of a sheep into a 15-year-old boy, who survived.

1818: First Recorded Human-to-Human TransfusionBritish Obstetrician Blundell performs the first recorded human-to-human blood transfusion. He injected a patient suffering from internal bleeding with 12 to 14 ounces of blood from several donors. The patient died after initially showing improvement.

Learning from examples….

Impact of World Wars1914: First Non-Direct Transfusion

1917: First Blood DepotArmy doctor collected/stored type O blood, in advance of the Battle of Cambrai in World War I.

1937: Term "Blood Bank" CoinedDr. Bernard Fantus at Chicago's Cook Co. Hospital coins the term "blood bank."

1922: Blood Donor Service Established Volunteers agree to be on 24-hour call and to travel to local hospitals to give blood as the need arises.

Do we have to wait for another World War to start believing in the power and possibilities of

Public UCB Banks across the nation?

I hope not !!!