UMBILICAL CORD BLOOD BANKING: Insurance Against Future Diseases?

• Author: WAGNER, HOLLY

Researchers are continuing to seek answers to the scientific and ethical questions surrounding this experimental and controversial medical procedure.

CINDY MONROE was pregnant with her first child when doctors found a malignant tumor on the tissue between her lungs. She had non-Hodgkin's lymphoma. What followed was an end to the pregnancy, six months of chemotherapy, and nearly a dozen radiation treatments.

She hit the five-year remission mark in May, 1999. Now 34, she and her husband, Chuck, have a four-year-old daughter and a two-year-old son. The birth of their son, Brent, provided the Monroes with a promise of "biological insurance" in case Cindy's cancer comes back or another family member develops one of myriad problems.

This biological insurance is a blood sample from Brent's umbilical cord which has been cryogenically stored at -385 [degrees] F in liquid nitrogen at a University of Arizona blood bank. It will remain there until it is needed. Cindy Monroe didn't think twice about saving her son's blood after she learned about the Cord Blood Registry (CBR)--a private cord blood bank based in San Bruno, Calif. --via a "Dear Abby" letter.

In most cases, placentas and umbilical cords were routinely tossed in the trash after a baby was born. Now, more than 10 years and over 1,500 transplants later, stem cells from umbilical cord blood seem like the wonder drug for treating many diseases. Expectant parents are increasingly faced with saving, rather than throwing away, this valuable resource.

Studies have shown the success of using umbilical cord stem cells to treat diseases such as leukemia, lymphoma, various anemias, and genetic disorders. Umbilical cord blood is a hematopoietic tissue, meaning it contains a mother lode of cells which give rise to the blood cells that carry oxygen, fight infections, and form clots in injured sites. Umbilical cord blood has even been billed as "an effective alternative to bone marrow transplant therapy" by the privately run New England Cord Blood Bank in Boston.

It almost seems too simple: Save a byproduct of the birth process and potentially save a life. Theoretically, it is simple. In practice, however, umbilical cord use, collection, and storage are still experimental and raise many controversial issues and questions. Should the blood be stored only for potential use by a family member or donated to a public bank? What is the likelihood of a family ever using its own sample? What about the costs that are involved?

Scientists in the early 1980s began studies that used umbilical cord blood stem cells in lab animal transplants. In 1988, a six-year-old boy from North Carolina with a rare, inherited blood disorder called Fanconi's anemia was the first person in the world to receive an umbilical cord stem cell transplant. His parents had conceived another child in hopes of producing a positive bone marrow match, but researchers gave the parents another alternative--use umbilical cord stem cells from his healthy sister. The transplant was successful.

A study on using umbilical cord blood for transplants appeared in the fall of 1998 in the New England Journal of Medicine. Scientists from the New York Blood Center and the Medical Centers at Duke University, New York's Mount Sinai Hospital, and Brooklyn (N.Y.) Hospital found that placental blood is a useful source of allogeneic hematopoietic stem cells for bone marrow reconstitution. This means that the recipient and the donor do not necessarily need to be related to each other to ensure a successful transplant.

Each year, 30,000 patients are diagnosed with a disease that could be treated with a bone marrow transplant, according to the National Marrow Donor Program in Minneapolis. The chances of finding a viable donor match vary because individual tissue types differ. Unlike bone marrow transplants, studies suggest that the stem cells from a cord blood donor sample need not perfectly match the recipient.

With umbilical cord blood banking, families can store the blood--for a price--for their own use, donate it, or choose neither. Family...