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Umbilical Cord Blood Provides a Source for Vital Stem Cells
By Wendy Harris
Post-Crescent staff writer
11 October 2005
What's considered medical waste by most saved 12-year-old Andrew Leonard's life.
The Medford boy was just 10 when he was diagnosed with acute myelogenous leukemia, a type of blood cancer where the bone marrow makes defective white blood cells.
After a grueling round of chemotherapy in the latter half of 2003, Andrew's cancer returned by late 2004. He needed new "adult-type stem cells," which traditionally come from a bone marrow donor. But none of his family members were a good match. Getting on the National Marrow Donor Program Registry waiting list meant wasting valuable time.
So his doctors at the University of Minnesota Medical Center, Fairview, opted for umbilical cord blood stem cells, thoughtfully and anonymously donated to a public cord blood bank by the parents of a healthy newborn.
After another round of chemo plus radiation to knock out his defective immune system, Andy was ready for his new stem cells. His transplant in February took about 15 minutes. With the processed cord blood suspended in an IV-like bag, gravity gently pushed the cells into Andy's vein.
"Using this medical waste gives hope to other people who desperately need it," said Stacy Leonard. "Babies are being born every day and it's being thrown away."
Umbilical cord blood is chock-full of primitive adult stem cells. Just like bone marrow stem cells, those found in cord blood are programmed to make new blood and immune cells. Cord blood is increasingly being used in place of bone marrow for transplants to treat more than 70 types of diseases. The technology and successes have been progressing, with more than 6,000 successful transplants so far in this country since the 1990.
Yet more than 11,000 Americans die each year waiting for a stem cell transplant, a third of whom are children. And even though 4 million babies are born each year in this country, cord blood donation is the exception, not the norm. There are only an estimated 100,000 to 125,000 units of cord blood available worldwide for transplant. An estimated 400,000 units are needed to satisfy current transplant needs.
That's something state Rep. Steve Wieckert, R-Appleton, is aggressively trying to change.
"It's tragic that cord blood is being thrown away," he said. "It's not being used and lives are being lost."
Wieckert is the author of Assembly Bill 270, which promotes the collection of umbilical cord blood. It would require doctors and other prenatal care providers to inform pregnant patients about the option of donating their baby's cord blood for free to a public cord blood bank, blood bank or plasma center. Gov. Jim Doyle is expected the sign the bill, which has passed both the Assembly and Senate.
The national Leukemia & Lymphoma Society, which is dedicated to finding cures to blood cancers, has given the bill a strong endorsement. So has Wisconsin Right to Life and Pro-Life Wisconsin. Pro-life groups support the bill because, unlike embryonic stem cells, cord blood stem cells are ethically uncontroversial.
Wieckert, who is also pro-life, has been stressing that point, too.
"These are not embryonic stem cells," he said. "It's not an ethical concern."
The Wisconsin Medical Society, which has a membership of about 10,000 physicians, has given the bill a lukewarm reception. It initially opposed the bill, citing concerns about government interference into the private doctor-patient relationship. Wieckert then tweaked the bill, adding a conscience clause and a liability clause. Doctors can opt out of telling pregnant women about umbilical cord banking if they personally object and will face no civil liability for doing so.
"We removed our opposition but it's not something the Wisconsin Medical Society is taking a strong position on," said spokesman Steve Busalacchi.
Public vs. private donation
As the mother of three children, Stacy Leonard remembers seeing the ads for private cord blood banking in parenting magazines when she was pregnant. She didn't give it much thought. It seemed so expensive. She didn't know she could donate her babies' umbilical cords, just like making an organ donation to potentially save a life.
"It's very expensive to save this for your own family," she said. "I never really considered doing (a public donation) because I didn't know a lot about it."
And most people don't. In fact, a nationally coordinated infrastructure to accept donated umbilical cord blood is still in its infancy.
Cryobanks International, of Altamonte Springs, Fla., is the only company that collects cord blood donations, free of charge, from anywhere in the continental United States. While there are more than a dozen other universities, hospital programs and blood banks that collect donated cord blood, they only do it in a selected number of nearby hospitals. There are no such facilities in Wisconsin.
"We'd love to take your donations," said Dwight Brunoehler, president of Cryobanks International. "Our goal as a company is to be able to provide cord blood stem cells to anyone in the world in need of a stem cell transplant. We are an inventory company and we take as many donations as we can."
Brunoehler helped Wieckert draft the umbilical cord blood legislation, which -- if signed by the governor -- will make Wisconsin the second state to have such a law on the books. Illinois was the first, and Brunoehler helped in that effort, too.
For the time being, collecting and processing cord blood, free of charge and for public use, is a money-losing business, Brunoehler said.
Unlike collecting blood, which is tested and typed, bagged and put in a refrigerator, processing and storing cord blood is much more expensive and complex. By law, cord blood must be processed within 48 hours of birth. That makes for expensive shipping costs.
Once in the lab, the cord blood is tested for bacterial and fungal infections, and a vial of the mother's blood is also tested for sexually transmitted diseases. If negative results come back, the cord blood is then tested for its six antigens, the distinct markers each of us have in our immune systems that make us different from others. Finally, it is stored in special bag and frozen in liquid nitrogen, at minus 321 degrees Fahrenheit.
Brunoehler says his company is able to afford free, public banking through other ventures, including offering private umbilical cord blood storage.
"We are the first hybrid model in the world," he said. "We will do private storages but we've never advertised it."
There are also about two dozen companies around the country that just offer private umbilical cord banking, where parents pay an average of $1,400 for collection and processing fees, plus roughly a $100 annual fee for storage.
Dr. Charles Sims, a board certified pathologist and founder of Family Cord Blood Services in Los Angeles, says about 2 percent to 3 percent of parents bank their baby's cord blood for private use. They are usually upper-middle class families who can afford the services, he said.
"It's a little bit like life insurance, the family's needs have to be looked at and it depends on what your family circumstances are," he said.
Wisconsin at the forefront
With a shortage of public banks available, Wieckert would like to see a major national cord blood center established in Wisconsin, continuing its tradition as a leader in stem cell research and use.
Earlier this month, the University of Wisconsin was appointed to become the nation's first and only National Stem Cell Bank. The National Institutes of Health picked the school to house, store and characterize the 22 embryonic stem cells lines that already exist in this country and are eligible for federal funding. The school already has five of the lines, which it developed.
"Wisconsin is such a great national and world leader in stem cell research," Wieckert said. "Umbilical cord research indicates that there is tremendous potential new cures for diseases."
A bill to fund a $79 million cord blood registry is pending before the U.S. Senate. It calls for setting up a national cord-blood banking network. Congress has already approved the bill.
If approved, Wieckert hopes Wisconsin could become part of the network. He said he plans to draft a new bill calling for the creation of public cord blood bank in Wisconsin.
New immune system, new hope
After Andy received his new stem cells, the waiting game began. Unlike bone marrow stem cells, cord blood stem cells take a little longer to "engraft," where they float around in the body's blood stream before settling into the bones and setting up shop to do their job.
Transplanted cord blood stem cells pose a much lower risk of graft-versus-host disease, where the donor stem cells attack the host's organs and tissues. That's because umbilical cord stem cells, which are very primitive at birth, haven't fully developed their antigen markers.
While a bone marrow transplant needs a six out of six match, a four out of six match will suffice for a cord blood stem cell transplant.
"The cord blood stem cells are naive and don't fully define until they are six weeks old," Brunoehler said. "That's why babies can catch diseases easily because their immune system isn't developed."
Another advantage of cord blood stem cells over bone marrow is accessibility, he added. It takes an average of four days to track down and retrieve a stored cord blood sample, while it takes about four months to find a potential donor marrow donor and acquire it.
"We didn't have four months," Stacy Leonard said.
On day seven after Andy's transplant, the family got good news. His body was making a few white blood cells. On day 28, doctors found all three types of blood cells -- white, red and platelets. And there was no sign of his old immune system, and the cancerous cells it used to make.
On day 33, he got to go home.
It's now been eight months and Andy remains cancer free. Finally, he's back to being a kid again, but with one major difference.
"He has matured beyond his years and we are very proud of him," Stacy Leonard said.
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On the Web
For more information on umbilical cord blood stem cell research and donation, visit the National Marrow Donor Program at www.marrow.com , or the Coalition for Responsible Cord Blood Donation at www.cordcoalition.com. The New York Blood Center’s National Cord Blood Program, the largest public cord bank in the country, can be reached at www.nationalcordbloodprogram.org
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How to become a donor
Cryobanks International, based in Altamonte Springs, Fla., is the only public cord blood bank that collects publicly donated umbilical cord blood, free of charge, anywhere in the continental United States seven days a week.
For more information, visit their Web site at www.cryo-intl.com or call 800-869-8608.
The first steps include signing an informed consent form, filling out a health questionnaire and getting a doctor’s order for blood testing, which will be drawn around the time of delivery at the hospital.
Donors are asked to discuss their desire to donate their baby’s umbilical cord blood with their doctor or prenatal care provider and find out if the they are willing to perform the collection.
The donor is expected to return the required forms with original signatures by the 35th week of pregnancy. If accepted as a donor, Cryobanks then sends a cord collection kit, complete with instructions, sterile vials and a collection bag, as well as an insulated box for mailing back the blood.
The donor brings the kit to the hospital for the delivery. Once the baby is delivered, the doctor or a hospital staff member will collect the blood remaining in the umbilical cord and placenta in the provided bag.
It is then the donor’s responsibility to notify Cryobanks within two hours after the cord blood collection. The company will dispatch a courier to promptly pick up the package.
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