Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. 1011-1017 (doi:10.1542/peds.2008-0436)
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ARTICLE

Private Cord Blood Banking: Experiences and Views of Pediatric Hematopoietic Cell Transplantation Physicians

Ian Thornley, MDa, Mary Eapen, MDb, Lillian Sung, MD, PhDc, Stephanie J. Lee, MD, MPHd, Stella M. Davies, MDe and Steven Joffe, MD, MPHf

a Department of Pediatrics, North Shore Medical Center, Salem, Massachusetts
b Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
c Division of Pediatric Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
d Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
e Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
f Department of Pediatric Oncology, Dana-Farber Cancer Institute, and Department of Medicine, Children's Hospital Boston, Boston, Massachusetts

OBJECTIVE. Private cord blood banks are for-profit companies that facilitate storage of umbilical cord blood for personal or family use. Pediatric hematopoietic cell transplantation physicians are currently best situated to use cord blood therapeutically. We sought to describe the experiences and views of these physicians regarding private cord blood banking.

PARTICIPANTS AND METHODS. We e-mailed a cross-sectional survey to pediatric hematopoietic cell transplantation physicians in the United States and Canada; 93 of 152 potentially eligible physicians (93 of 130 confirmed survey recipients) from 57 centers responded. Questions addressed the number of transplants performed by using privately banked cord blood, willingness to use banked autologous cord blood in specific clinical settings, and recommendations to parents regarding private cord blood banking.

RESULTS. Respondents reported having performed 9 autologous and 41 allogeneic transplants using privately banked cord blood. In 36 of 40 allogeneic cases for which data were available, the cord blood had been collected because of a known indication in the recipient. Few respondents would choose autologous cord blood over alternative stem cell sources for treatment of acute lymphoblastic leukemia in second remission. In contrast, 55% would choose autologous cord blood to treat high-risk neuroblastoma, or to treat severe aplastic anemia in the absence of an available sibling donor. No respondent would recommend private cord blood banking for a newborn with 1 healthy sibling when both parents were of northern European descent; 11% would recommend banking when parents were of different minority ethnicities.

CONCLUSIONS. Few transplants have been performed by using cord blood stored in the absence of a known indication in the recipient. Willingness to use banked autologous cord blood varies depending on disease and availability of alternative stem cell sources. Few pediatric hematopoietic cell transplantation physicians endorse private cord blood banking in the absence of an identified recipient, even for mixed-ethnicity children for whom finding a suitably matched unrelated donor may be difficult.

Key Words: hematopoietic stem cell transplantation • cord blood stem cell transplantation • bioethics

Abbreviations: HCT—hematopoietic cell transplantation • AAP—American Academy of Pediatrics • CIBMTR—Center for International Blood and Marrow Transplant Research • NMDP—National Marrow Donor Program • IQR—interquartile range • SAA—severe aplastic anemia • PBSC—peripheral blood stem cells • MSD—matched sibling donor • URD—unrelated donor • ALL—acute lymphoblastic leukemia • HLA—human leukocyte antigen

Accepted Jul 15, 2008.


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