Question

​The use of public and private cord stem cell banks is increasing. Discuss this statement and the controversy it generates.

Answer 1

Because

Risc of cord stem cell banking-

It also seems to be less likely than bone marrow to cause immune rejection or complications such as Graft versus Host Disease . This means that cord blood does not need to be as perfectly matched to the patient as bone marrow (though some matching is still necessary).

Why people increasing to make stem cord cell banking-

• The umbilical cord fluid is loaded with stem cells. They can treat cancer, blood diseases like anemia, and some immune system disorders, which disrupt your body's ability to defend itself. The fluid is easy to collect and has 10 times more stem cells than those collected from bone marrow

• Hematopoietic stem cell transplantation (HSCT) is common practice today for life threatening malignant and non‐malignant diseases of the blood and immune systems.

• The UCB industry has been influenced by a diverse range of factors. A period of rapid growth occurred as a result of the increasing acceptance of HSCT and the use of UCB as an alternative to BM‐derived HSCs (harvested directly or following mobilization into peripheral blood). However, the emergence of haploidentical HSCT has resulted in a decline in the use of UCB and a plateau in global inventories. This downturn has been compensated for partially by an increase in the use of UCB for regenerative medicine purposes, albeit mostly in clinical trials. Adding to this dynamic is the question of economics. The high cost of allogeneic UCB transplantation is a challenge for many patients, which is further impacted by the FDA requirement for licensure of units in the U.S. For public banks, the cost of banking UCB units is only recovered if units are sold to HLA‐matched recipients. Ongoing subsidies are thus necessary, and the fact that 90% of public banks are unable to self‐sustain is clearly not conducive to growth. In contrast, private banks secure their income in advance or soon after banking UCB units, and hence sustainability is not dependent upon the sale of units. The net result is that the global inventory held by private banks exceeds four million units—nearly seven times that of public banks.

• Umbilical cord blood (UCB) is rich in hematopoietic stem cells (HSCs) and is an attractive alternative to harvesting HSCs from bone marrow or when mobilized into peripheral blood.

• One of the most appealing attributes of UCB is that it can be banked for future use and hence provides an off‐the‐shelf solution for patients in urgent need of a transplantation.

• This has led to the establishment of publicly funded and private UCB banks, as seen by the rapid growth of the UCB industry in the early part of this century. However, from about 2010, the release of UCB units for treatment purposes plateaued and started to decrease year‐on‐year from 2013 to 2016.

• Our interest has been to investigate the factors contributing to these changes. Key drivers influencing the UCB industry include the emergence of haploidentical HSCT and the increasing use of UCB units for regenerative medicine purposes.

• Further influencing this dynamic is the high cost associated with UCB transplantation, the economic impact of sustaining public bank operations and an active private UCB banking sector. We foresee that these factors will continue in a tug‐of‐war fashion to shape and finally determine the fate of the UCB industry