Cord Blood Banking for Potential Future Transplantation – What’s new?

Recently an updated version of “Cord Blood Banking for Potential Future Transplantation” policy statement has been published under authority of American Academy of Pediatrics.

Almost 10 years passed since the first version of  “Cord Blood Banking for Potential Future Transplantation” has been published in “Pediatrics” journal.

The authors point out that revising of the article content is the result of increasing need for cord blood transplantation in children with malignancies, hemoglobinopathies (blood disorders caused by changes of the main component of red cells – hemoglobin), primary immunodeficiencies (genetically diseases of immune system components) , and metabolic diseases.

By 2013, worldwide more than 30 000 of cord blood transplantation have been performed in children and adults, for:

  • Malignancies (57%)
  • Hemoglobinopathies (32.5 %)
  • Severe combined immunodeficiency disease (SCID) or related T-lymphocyte disorders (6%)  and
  • Other disorders‍ (1.5%)

Besides the increasing number of patients referred for blood forming stem cells transplantation, during this decade many important steps have been taken in the development of:

  • Improving cord blood banking standards and regulations
  • Standard indications and improving the outcome of cord blood stem cell transplantation
  • Emerging field of regenerative medicine and stem cell therapy

All along this post we will go through each of these, as appear reflected in the new version of “Cord Blood Banking for Potential Future Transplantation” document.

Let’s start our review with the intro statement of the authors regarding its purpose:

 “This policy statement is intended to provide information to guide pediatricians, obstetricians, and other medical specialists and health care providers in responding to parents’ questions about cord blood donation and cord blood banking as well as the types (public versus private) and quality of cord blood banks.*”

The first 10 take-home messages are as follows:

  1. “Cord blood is an excellent source of stem cells for blood forming stem cell transplantation in children with some fatal diseases.*
  2. “Cord blood transplantation offers another method of definitive therapy for infants, children, and adults with certain hematologic malignancies, hemoglobinopathies, severe forms of T-lymphocyte and other immunodeficiencies, and metabolic diseases*
  3. The number of cord blood transplants is likely to increase in the future, as long as the universal screening tests for severe immunodeficiency develop and are implemented. Statistically, the according to the last estimations it is proved that incidence of Severe combined immunodeficiency disease (SCID), requiring a blood forming stem cells transplantation is 1 in 58 000 live births.
  4. Educating medical personnel, parents, and the public about the increasing need and uses of cord blood banking is one of the most important measure which has to be taken promptly.
  5. The number of cord blood units used in transplantation for adults (patients >16 years) has progressively increased over the past decade.
  6. The immunological features of umbilical cord stem cells provide a significant advantage in finding a compatible partially matched graft, compared to other sources: bone marrow or peripheral blood.
  7. Emerging expansion techniques shows promising results in overcoming the limited number of stem cells contained by cord blood units.
  8. For children having established the indication of blood forming stem cells transplantation as curative treatment option for leukemia, only donated cord blood unit could be used.

Their own cord blood stem cells already contain genetic mutations predisposing for leukemia development, according to the preclinical studies results published in ‘90s.

  1. In the families with a history of diseases treatable by blood forming stem cells transplantation, including genetic defects there can be a need for directed cord blood banking.

In such cases families can approach local family banks, which could even have a special program or local public banks.

  1. The development of regenerative field by emerging the results of finished or ongoing clinical trials may have an impact on the cord blood banking in the future. Autism spectrum disorder (ASD), cerebral palsy (CP), hypoxic ischemic encephalopathy (HIE), diabetes (DM), systemic lupus erythematosus (SLE), systemic sclerosis (SS) and Alzheimer are some of the diseases for which clinical trials have provided encouraging results.

Further studies are still needed, to confirm first results on larger cohort patients.

Comparative aspects, general considerations and recommendations regarding to cord blood  banking as public donation or as family storage, as are presented in this document will be the subject of the next post.

Source:

* Shearer WT, Lubin BH, Cairo MS, et alAAP SECTION ON HEMATOLOGY/ONCOLOGY, AAP SECTION ON ALLERGY AND
IMMUNOLOGY. Cord Blood Banking for Potential Future
Transplantation. Pediatrics. 2017;140(5):e20172695

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