Why do we need to have cord blood donated to public cord blood banks?

1. Cord blood donated to a public bank provides another source of hope for patients who have no matching donor in their own family, no unrelated donor in bone marrow donor registries that is a suitable match or no time to find a donor. Increasingly, cord blood is becoming the first choice for children as a source of stem cells. Just like bone marrow, cord blood stem cells are capable of generating all the cellular elements in the blood and immune system.

2. Donated bone marrow or peripheral blood containing mobilized stem cells have been the traditional sources of hematopoietic stem cells for transplantation. Their donors usually must be perfectly matched to the recipient; that is, matched at least for the HLA-A, -B and -DRB1 antigens. Since there are usually two antigens for each, in a perfect match, the donor will have the same six antigens as the patient, a 6/6 match. A perfect match is easiest to find among family members. A brother or sister of a patient, for example, has a 25% chance of being a perfect match. Because the average number of children in U.S. families is slightly more than two, about 3 out of 10 patients will find a match among their own siblings. Other blood relatives also may be well-matched but the chance is much lower.

When no relative is available, some other source of stem cells must be found. Bone marrow for unrelated donors has helped solve this problem for several thousand patients. Marrow donor registries around the world have recruited several million volunteers willing to donate their bone marrow to a perfect stranger. The largest registry in the United States is the National Marrow Donor Program (NMDP) which lists over 5 million volunteers.

3. Many patients who need a bone marrow transplant, however, cannot find a suitable donor - no relative that matches and no match among volunteer bone marrow donors. According to a report from the U.S. Government Accounting Office (GAO) released in October 2002, 10,000-15,000 people in the U.S. each year have a disease that could be treated with a transplant, but have no HLA-matched related donor. About one-third of these patients try to find an unrelated marrow donor through the NMDP but only 25% of them (9% of the total who might benefit) actually get a transplant. The odds are even worse for African-American and other ethnic minority groups.

4. Fortunately, a cord blood transplant does not have to be a perfect match to the patient. Adult bone marrow contains immune cells (so-called T-lymphocytes or T-cells) that are fully mature. When transplanted, these T-cells may attack the patient's own cells, causing a condition called graft vs. host disease (GvHD), which can be severe and even lethal. T-cells in cord blood do not appear to be as "immunologically mature" as those in bone marrow. As a result, cord blood transplants are less likely than bone marrow to cause GvHD and, when it does occur, is often less severe. [Click here to read more about the advantages of cord blood]. Because cord blood transplants cause less GvHD, the match to the patient does not need to be perfect. In fact, most cord blood transplants so far have been 5/6 or 4/6 matches for HLA-A, -B and -DRB1 antigens. This means that patients who cannot find a perfectly matched bone marrow donor may have a chance to find a suitable cord blood transplant. Patients with rare HLA types, African-Americans and members of other minority groups, therefore, benefit especially from this stem cell resource. [Click here to read about cord blood's significance for ethnic minorities].

Spencer Barsh, transplanted for adrenoleukodystrophy, a genetic disease, and Jaclyn Albanese, transplanted for acute myelogenous leukemia, seen together before a press conference in Washington, D.C. in October 2003 to announce the introduction of the Cord Blood Stem Cell Act of 2003.