Family cord blood banking for sickle cell disease: a twenty-year experience in two dedicated public cord blood banks
Hematopoetic stem cell transplantation (HSCT) is currently the only curative therapy for sickle cell disease. However, there remain challenges in both identifying appropriate donors, and reluctance to proceed to HSCT due to transplant-related toxicity. Umbilical cord blood transplant (CBT) from family donors has cure rates exceeding 90%, with low rates of GvHD. This retrospective review aimed to assess the characteristics, utilization, and transplant outcomes of family-directed cord blood of patients with sickle cell disease. This study was driven, at least in part, by the cost and technical challenges of collecting and storing units
Free cord blood banking in public cord banks was offered to women who had previously delivered a child with sickle cell disease. Despite being a public bank, cords were reserved for the use of that family. All cords were stored and HLA-testing was not done (due to cost) unless requested by treating physician. Data were collected retrospectively from the cord blood bank, Eurocord registry and hospital patient records.
338 units were collected from 302 families. 28 units were used for transplantation, giving a utilization rate of 8% over 20 years. Interestingly, one center accounted for 41% of all cords banked, and utilization of 25/28 cords. This suggests that close collaboration with transplant teams is likely to increase cord blood use. There was a 96% engraftment rate and 100% survival, with all patients achieving a minimum of 80% donor chimerism. 5/28 patients had Gr.II-IV aGvHD requiring steroids.
There are no data reported on cost of cord blood banking. This is a significant omission in discussing publicly funded cord banking, particularly in light of low utilization rates.