Family Cord Blood Banking: Experience and Views of Pediatric Hematopoietic Stem Cell Transplant Physicians.

Abstract

Background: In recent years, there has been a proliferation of family cord blood banks (for-profit companies that facilitate the collection and storage of umbilical cord blood for personal or family use), which advertise widely to physicians and the public.Aims/Methods: To learn more about the experiences and views of pediatric HSCT physicians in the USA and Canada regarding family cord blood banking, we surveyed physicians identified through the IBMTR. We received completed surveys from 94/130 (72%) eligible respondents from 58 centers.Results: Forty-eight (51%) respondents were program or clinical directors. A total of 7 autologous cord blood transplants were performed at 6 centers, for severe aplastic anemia (SAA; n=3), neuroblastoma (n=1), retinoblastoma (n=1), Shwachman-Diamond syndrome after allogeneic graft failure (n=1), and diagnosis not stated (n=1). None of these grafts were supplemented with PBSCs or marrow. Primary graft failure occurred after one of these transplants. Thirty-six allogeneic family-banked cord blood transplants were performed at 16 centers for leukemias (n=19), hemoglobinopathies (n=6), Fanconi anemia (n=5) and other diseases (n=6). Cord blood was derived from siblings in all but one case. In 32/36 (89%) cases, the cord blood had been collected in light of a known disease in the index patient. Six of these allogeneic cord blood units were co-administered with marrow grafts. Primary graft failure occurred after 4/36 transplants. To determine the perceived utility of family-banked cord blood for the treatment of pediatric transplantable diseases, subjects were presented with a hypothetical 5 year-old child whose cord blood was banked at birth and who subsequently developed a potentially transplantable illness. To treat ALL in CR2 after on-therapy marrow relapse, none would choose the auto-cord over an HLA-matched sibling (MSD) graft, and only 6% would choose the auto-cord over a suitably matched and cellular URD marrow/cord blood graft. If no MSD or URD graft were available, 62% would use the auto-cord rather than pursue other therapy. To treat newly diagnosed SAA, 28% would choose the auto-cord over a MSD graft. To treat SAA refractory to immunosuppressive therapy, 55% would choose to transplant using the auto-cord instead of an URD graft. To treat high-risk neuroblastoma, 55% would choose to use the auto-cord for transplant, rather than autologous PBSCs/marrow. Finally, subjects were asked whether they would recommend family cord blood banking for a newborn with a healthy 3 year-old sibling. When both parents were of Northern European descent, no respondent recommended banking (25% neutral, 47% recommended against, and 28% strongly recommended against). When parents were of mixed ethnicity, only 11% recommended banking (with 32% neutral, 42% recommending against, and 15% strongly recommending against).Conclusions: There is little experience with transplantation of cord blood “prophylactically” stored in family banks, and situations in which pediatric HSCT physicians might choose to perform such a transplant are very rare. The vast majority of pediatric HSCT physicians do not recommend prophylactic storage of cord blood, even in mixed-ethnicity families.