Online Health Chat with Matt Kalaycio, MD
August 29, 2012
Cleveland_Clinic_Host: What are the advantages and disadvantages of umbilical cord blood (UCB) collection and storage? Is it a good idea for parents to consent to umbilical cord blood collection from newborns for storage with UCB collection companies?. Are there any risks to the mother or newborn? Umbilical cord blood is a rich source of blood stem cells, which can substitute for adult bone marrow as a source of stem cells for bone marrow transplant. Thousands of UCB transplants have been successfully performed, especially in children. The availability, and potential efficacy, of UCB as a treatment for otherwise fatal illnesses like leukemia have prompted some to recommend that all UCB be collected and stored as a safety precaution for the future. UCB collection for the treatment of life-threatening illnesses is not limited to the newborn donor, and may benefit immediate family members who are matches. These recommendations have led to an industry organized around the collection and storage of UCB.
The companies that have been set up to collect and store UCB advertise their services to expecting parents. They offer the potential for security against future serious illness for a significant fee. Parents, however, are not well informed about the probability that their child, or anyone else in their family, will contract one of those illnesses. Parents should be aware of the likelihood of UCB use, as well as alternatives to privately stored UCB for the potential treatment of illnesses.
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About the Speakers
Matt Kalaycio, MD, FACP is Director of the Bone Marrow Transplant Program and Chronic Leukemia and Myeloma Programs at Cleveland Clinic Taussig Cancer Institute. Dr. Kalaycio holds a joint appointment in Cleveland Clinic's Transplant Center and is a staff member in the Department of Hematologic Oncology and Blood Disorders, in addition to being a Professor in the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Board-certified in hematology, medical oncology and internal medicine, Dr. Kalaycio's clinical interests are in leukemia and stem cell transplantation.
Dr. Kalaycio has been published in numerous scientific publications including Bone Marrow Transplantation, Journal of Clinical Oncology, and Leukemia. He also is the editor of a book on leukemia and co-editor of a book on clinical malignant hematology. His research interests focus on testing new treatments for leukemia.
Dr. Kalaycio graduated from West Virginia University School of Medicine in Morgantown, W.V. He completed his residency in internal medicine at Mercy Hospital of Pittsburgh, Pa., and fellowships in hematology and medical oncology and bone marrow transplantation at Cleveland Clinic.
Let’s Chat About Umbilical Cord Blood Preservation and Stem Cells for Bone Marrow Transplant
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic expert Dr. Matt Kalaycio. We are thrilled to have him here today for this chat. Let’s begin with some of your questions.
Current Use and Probability of Use
jestpo: Can you explain which conditions or diseases could potentially be treated with stem cells from cord blood?
Dr_Kalaycio: Mostly leukemia, but any disease affecting the bone marrow and blood can be treated, including sickle cell anemia and other similar blood disorders.
clapper: Should cord blood be preserved only for those at risk for hereditary disease, or is it being recommended now for all deliveries given the future of stem cell research?
Dr_Kalaycio: It is being recommended for everybody, so everyone will have a greater chance of having a match if they need stem cells from umbilical cord blood.
doni: When donating to a public bank, is it used only for treatment or could it be used for research?
Dr_Kalaycio: A little of both, but mostly treatment. There is a separate consent process to save some of the cells for research purposes, but the number of collected cells is so small that we cannot use much of any single unit for research purposes.
find_out: What are the odds that saved umbilical blood can be used for anyone in the immediate family? My niece has been just diagnosed with leukemia. I am seven months pregnant. Can this help her?
Dr_Kalaycio: The odds are very small. Based on some recent data, the likelihood of needing a stem cell transplant from any source is 1 in 217 for an individual (by age 70). However, at least half of all transplants entail using the patient's own stem cells. The vast majority of the rest come from matched siblings or matched unrelated donors. The need for cord blood for any one person is exceedingly small.
Perry: Can UCB stem cells be used for other diseases that are not blood related? Is there a potential that these stem cells will be someday be able to grow organs?
Dr_Kalaycio: Yes, they might be used to treat non-blood related diseases like heart attacks or multiple sclerosis, but not yet. Other uses for UCB are very much still in the research stage. Growing organs will pose an even greater challenge, but in theory could happen some day. However, it is likely that it will be easier to do this with embryonic stem cells.
kdskcmjrs: Are there statistics on how many people per year are transplanted with their own privately stored cord blood cells?
Dr_Kalaycio: I don't know of any, but that would be a great question for the private banks to answer. I bet the answer is very few.
summer24: How is cord blood actually obtained once I have my baby? How much blood and stem cells does an umbilical cord hold?
Dr_Kalaycio: When the placenta is delivered, it is hung from a pole and the blood within is dripped into a collection container. The amount collected varies considerably, but there are usually enough stem cells to transplant into a child, but not enough to transplant into an adult. That is why we often use two units to transplant an adult.
first_things_first: Do all hospitals collect umbilical cord blood for preservation, or do you need to go to a specialized facility?
Dr_Kalaycio: Not all hospitals collect UCB. However, you can have a collection kit sent to the OB (obstetric) physician from either a private bank or a public bank to allow collection anywhere as long as the OB agrees.
nodo: With pregnancy, do the doctors automatically discuss the possibility of umbilical blood collection, or is that something the expecting parents need to bring up with their doctor?
Dr_Kalaycio: I don't know if it is automatic or not. I suspect not, so it would be wise to bring it up if the OB (obstetrician) does not. It takes a little time to get the kit sent, so don't wait until the day of delivery!
star_power: What are the risks to the health of the mother and baby at the time of collection?
Dr_Kalaycio: None. The cells are collected after the placenta is delivered.
sully: Is there a weight limit to patients having a cord transplant? My husband is over 200 pounds.
Dr_Kalaycio: There is not a weight limit per se, but the larger the patient the more stem cells are needed. Since cord blood has very few stem cells in each unit, there are very few single units that can be used. However, we have learned to use multiple units for transplant, and this makes cord blood transplant available for larger patients.
clandon: Are there any scientific information or recommendations concerning UCB collection and H1N1 vaccination during pregnancy?
Dr_Kalaycio: Although I am unaware of any specific recommendations regarding cord blood storage, the flu vaccine is recommended for all pregnant women and there is no exception for those planning to donate cord blood.
Shelf Life of UCB
swadesh: How long can the umbilical cord blood be preserved to be useful for a future bone marrow transplant or for use in any other condition? Can the umbilical cord blood be preserved indefinitely, or is there a time limit that would make it useless for the child to use his or her own umbilical cord blood cells (stem cells) if he develops a condition say at 40 years of age? How likely is a child to be able to use his own preserved umbilical cord blood cells(stem cells) in his lifetime?
Dr_Kalaycio: The cells are cryopreserved and available indefinitely. There is no time limit. However, the chance that anyone would ever actually need their own stored cells is exceedingly small even over a full lifetime.
dolly: My daughter's cord blood was stored. My husband has been told he needs a bone marrow transplant, and so far they cannot find a match. They tested my blood type and we were told they could tell that from this the cord blood would not be a match. The cord itself has not been tested. I read somewhere that most any cord blood would work. What is true? Do we disturb the stored blood for a test or not?
Dr_Kalaycio: They are correct that blood tests can answer the question of matching. I would not thaw out the unit to confirm. Not just any cord blood will work. There has to be a degree of matching between the unit and the recipient.
really: How close a match is umbilical cord blood between siblings? Twins?
Dr_Kalaycio: The match is determined by the random mix of genes from the parents, so the chance of an exact match among siblings is one in four. If they are fraternal twins, the one in four rule applies. Identical twins are always 100 percent matched.
Private vs. Public UCB Banking
right_for_me: Clarify the advantages and disadvantages of private cord blood banking as compared with public cord blood banking. Please also clarify how long can cord blood be preserved? Is it for say 100 years or much less like 25 years?
Dr_Kalaycio: There are few advantages and many disadvantages for private cord blood banking. First, it costs money and public banking is free. Second, the odds of any one person needing to use cord blood to treat a disease is extremely small, but the odds of someone else in the world needing cord blood is much greater. Third, public banks have better government oversight than do private banks, resulting in better regulation of quality control measures. Finally, once a unit is placed in a private registry, it cannot be transferred to a public registry, and, therefore, cannot be made available to the public at large—especially for minority groups who need them the most. It is preserved forever as far as we know.
Pinky123: Can you please explain the difference between private and public cord banking? I see you noted many disadvantages to private cord banking, but wouldn't that be the only option that would guarantee your child has access to their own cord blood if they needed it later on?
Dr_Kalaycio: Private cord blood banks operate to collect and cryopreserve cord blood cells for the family doing the donation. Public banks collect and cryopreserve for anyone who may need them. Importantly, though, the chances that a privately stored unit will ever be used are very small.
summer24: What are the benefits of saving cord blood?
Dr_Kalaycio: If you save through a private bank, the benefit is the availability of that unit for your family for a price. If you save through a public bank, the benefit accrues to society more than to you for free. Cord blood transplants are used to treat leukemia, other cancers, and some childhood diseases.
donna: Why is there even any debate over this? And why is there a collection fee for the public banks? (I can understand private banks.) If it saves lives and the patient agrees, where is the problem? You don't have to pay to donate blood, etc, why this? It should be done as a matter of course (with the patient’s permission, of course.)
Dr_Kalaycio: There is no collection fee for public banks, it is done for free. Otherwise, I agree with you.
UCB vs. Embryonic Stem Cells
happy_days: Is there a difference between cord blood stem cells and embryonic stem cells?
Dr_Kalaycio: Yes. With today's technology, there is a limit to the type of tissue cord blood cells can develop into. There is no limit to the way embryonic stem cells can develop. Also, cord blood stem cells come from the placenta after delivery while embryonic stem cells have to come from a fetus early in the pregnancy.
Celena: I am confused ..What is the difference between cord blood stem cells and embryonic stem cells? Is that potentially what the controversy is all about?
Dr_Kalaycio: Embryonic stem cells come from the earliest fetal tissue right after conception. Cord blood cells come from the placenta after delivery of the child. Embryonic stem cells are only being used for research purposes these days, while cord blood cells are routinely used to treat diseases like leukemia. The controversy lies with embryonic stem cells and the methods used to obtain them. There is no controversy about the collection process for cord blood cells.
Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic expert Matt Kalaycio, MD is now over. Thank you Dr. Kalaycio for taking your time to answer our questions today about Umbilical Cord Blood Preservation & Stem Cells for Bone Marrow Transplant.
Dr_Kalaycio: Thank you for your participation today. I hope I cleared up some misconceptions about cord blood collection. Please let us know if, on the basis of this web chat, you choose to donate cord blood to either a private or public bank by emailing firstname.lastname@example.org
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