Reevaluating the import of cord blood banking in regenerative medicine

“Private cord blood banking is not a ‘biological insurance’ and its role in regenerative medicine is still hypothetical. [It] is recommended only if there is an existing family member (siblings or biological parents only), who is currently suffering from diseases approved to be benefitted by allogenic stem cell transplantation”

June 22, 2023 07:04 pm | Updated 07:04 pm IST

Blood being extracted in the operation room.

Blood being extracted in the operation room.

A few days before her baby girl was born on June 20, 2023, Upasana Kamineni, wife of actor Ram Charan, announced on Twitter that she had chosen to preserve her baby’s cord blood. She’s not the first celebrity to have done so. A while ago, Aishwarya Rai Bachchan said she too, had saved cord blood.

Umbilical cord blood is a rich source of stem cells that can potentially develop into different types of cells, and be used, via a transplant, in the treatment of certain blood, immune and metabolic disorders. These are known as hematopoetic stem cell transplantations (HSCT) and require certain markers to match between the cord blood and the patient, to work.

While over the past decade or so the popularity of cord blood banking has increased among new parents, witnessed by the many banking facilities that have come up across the country, doctors’ associations say private banking of cord blood is not a routine recommendation for pregnant women, its use in transplants is decreasing and the areas of regenerative medicine where it could potentially be used, are still, mostly, experimental.

In 2009, when Sumana* was pregnant with her second child, she decided to consider cord blood banking. “At that point there was a family history of several illnesses: cancer, heart disease and diabetes, and this was seen as a once-in-a-lifetime chance to preserve stem cells,” says the 45-year-old Delhi-based professional. For other mothers, like Jaya Sara Varghese, a Bengaluru-based public relations professional, the motivation was primarily a desire to not regret her decision in the future. “When my daughter turns 18, she will take a call on whether to continue banking it or not,” Ms Varghese says.

LifeCell International, one of the country’s big names in stem cell banking says it currently has a presence in over 200 cities. “In a year, we have signed up around 25,000 customers,” says managing director, Mayur Abhaya. The problem of a struggle for a match, he said, has been solved through the company’s community blood banking system.

‘Community’ or ‘social’ banks, are repositories of stored cord blood from multiple donors, accessible to those who register for these services with the stem cell banking companies. Gurugram-based Cryoviva Biotech says the firm offers private as well as social banking. The stored stem cells remain the property of the client for the first two years after which they are transferred to the social banking repository, said Sajesh Padman, manager of the company’s southern operations

“To find a match you need a large pool of donors,” says Mr. Abaya. “Since we have 80,000 cord blood units stored with us, we are able to provide a good match.” Cryovia says it has over 40,000 units of cord blood stored. Cord blood banking, can cost patients thousands of rupees.

The Bohari family from Maharashtra is one that used this community banking option. Four-year-old Batul Bohari, a resident of Sangamner, was diagnosed in 2018 with aplastic anaemia, a rare condition in which the body stops producing enough new blood cells due to the failure of bone marrow development. Initially, Batul was treated with medications, but slowly her condition deteriorated. When Batul’s mother became pregnant again, the family decided to store the baby’s cord blood, opting for community banking. But even this did not help Batul when she needed it, as her baby sister’s blood was only a 50% match. 

“We were aghast. The doctor said two closely-matching cord blood units could be used, and we eventually managed to obtain a second unit from the community pool. The transplant took place in October 2020,” Batul’s  father, Huzefa Bohari said.

But in general, what are the chances of stored cord blood being used? A FAQ on cord blood banking by the Indian Council of Medical Research (ICMR) says “the likelihood of the stored blood being used for HSCT is very small, probably as low as 0.005 to 0.04% in the first 20 years of life.” Consensus has also emerged in recent years, that stored cord blood should not be used for treating one’s own genetic condition in the future, because these stem cells could harbour the same genetic abnormality that caused the primary disease.

Of late, the use of cord blood in transplants has been on the decline, says Revathi Raj, paediactric hemato-oncologist at Apollo Hospitals, Chennai. “Up until about five years ago, stem cells from cord blood were used for transplantations in children who had inborn errors of immunity or metabolism: the transplanted stem cells could help cure these genetic conditions. Now, however, a newer method - haploidentincal transplants - is more common, where healthy cells from a half-matched donor such as a family member are used to replace the unhealthy ones in a patient.” This method, she says, is faster and has a higher success rate. She however expressed the belief that emerging technologies to increase the number of cells in cord blood units and promote faster growth of new blood cells, may help the future use of cord blood. 

The ICMR’s ‘Guidelines for Umbilical Cord Banking’ 2023 too state that the trend is decreasing utilisation of cord blood for transplants in recent years. “Presently, the cord blood stored in private cord blood banks remains under-utilised,” it adds.

None of the professional obstetric-gynaecological associations recommend cord blood banking as a matter of routine to pregnant women, says P. Rafeeka, senior consultant in Gynaecology and Obstetrics, KIMSHEALTH, Thiruvananthapuram. “We don’t proactively recommend it, we only discuss it if patients ask us about it,” says Jaishree Gajaraj, former president of The Obstetric & Gynaecological Society of Southern India. Chennai-based gynaecologist Priya Selvaraj concurs. Vidya Bhat, former president of Karnataka State Obstetrics and Gynaecology Association, said around 20% of her patients enquire about stem cell banking and some of them, with insurance cover for banking, opt for it.

The Indian Academy of Paediatrics, in a 2018 statement, said: “Private cord blood banking is not a ‘biological insurance’ and its role in regenerative medicine is still hypothetical. [It] is recommended only if there is an existing family member (siblings or biological parents only), who is currently suffering from diseases approved to be benefitted by allogenic stem cell transplantation.”

For would-be parents considering cord-blood banking, awareness is important. “There is still a lack of awareness among stakeholders about the uses of cord blood banking. This needs to be countered through widespread information dissemination,” says a senior ICMR official.

*Name changed to protect privacy

(With inputs from R. Sujatha in Chennai, C. Maya in Tiruvananthapuram and Afshan Yasmeen in Bangalore)

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