Making the Case for Private Cord Blood Banking: Mission Accomplished!

Abstract

In our recent review [1] we provided a rational and evidenced based argument for the role of private cord blood banking in the developing field of cord blood stem cell technology. We were delighted to see that our review stimulated Schmidt et al., [2] to write a reply to our ideas as it was our intention to stimulate academic debate in this important area. The key message in our review is that private cord blood banking provides cord blood units which have a potential use as a source of stem cells for allogeneic transplant within the family and that those same units also have potential in future regenerative medicine procedures. The current arguments against private cord blood banking, especially by the professional bodies, focus on the limited use of private cord blood units in autologous transplantation. We do not challenge the fact that autologous transplantation of privately stored cord blood units is rare, we simply want to ask such critics to look beyond autologous transplantation in the context of the potential clinical utility of privately stored cord blood units. Equally importantly, we do not support misleading marketing by private cord blood banks which is in fact a rarity in the modern, highly regulated industry. Schmidt et al., claim that bone marrow donation is a ‘safe procedure’ but compared to cord blood collection it carries more risk. Bone marrow donation can cause pain at the collection site and fatigue and pain on walking or sitting in 6–20% of donors. Major and even life threatening complications such as anaesthesia related events, mechanical injury to bone, the sacro-iliac joint and the sciatic nerve occur in 0.1–0.3% of bone marrow donors [3]. It is a little surprising that, in a debate at this level, Schmidt et al., state that there is a ‘significant delay in granulocyte and platelet engraftment after related CB transplantation’. This is basic knowledge to everyone working in the field of haemopoietic stem cell transplantation [4] and is managed by competent transplant teams and new approaches such as double cord transplantation. This limitation applies to all types of cord blood transplantation, regardless of their source, and has no specific relevance to the private cord blood banking debate. It is equally confusing that Schmidt et al., choose to challenge our citation of Gluckman et al., [5] to support our concepts on the desirability of cord blood from related sources. The clear conclusion of Gluckman et al., is ‘Cord blood is a feasible alternative source of hematopoietic stem cells for pediatric and some adult patients with major hematologic disorders, particularly if the donor and the recipient are related’. It seems inconsistent to challenge the point we were making when it is clearly and independently supported by Gluckman et al. Schmidt et al., go one to suggest that bone marrow transplantation is the ‘standard approach’ when donor and recipient are HLA-identical and suggest that double cord blood transplants are in some way inferior. This paragraph suggests a lack of understanding of the field in general as an identical HLA match between bone marrow donor and recipient is rare and double cord blood transplants are only P. Hollands (*) Senior Lecturer in Biomedical Science, University of Westminster, 115, New Cavendish Street, London, UK e-mail: hollanp@wmin.ac.uk