Transplants of stem cells from umbilical cord blood have saved the lives of roughly 20,000 Americans with leukemia, lymphoma, sickle cell anemia and several other illnesses in recent years.

The report, which was requested by Congress, also recommends that the Health Resources and Services Administration (HRSA) issue a call for proposals in order to identify an organization that can coordinate and manage daily blood-banking and allocation nationwide in a new Cord Blood Coordinating Center.

Thousands Die Waiting

Umbilical cords, a byproduct of normal childbirth, are a good source of hematopoietic progenitor cells (HPCs), the type of stem cells also found in bone marrow that give rise to various kinds of blood cells.

Transplants of these stem cells have saved the lives of roughly 20,000 Americans with leukemia, lymphoma, sickle cell anemia and several other illnesses in recent years, the report notes.

Still, thousands of patients die every year waiting for a transplant match. Although 22 public banks have been established in the United States to collect, store and distribute donated cord blood containing these cells, the report points out that these banks operate without any centralized coordination.

"The lack of centralized organization, universal quality standards, and uniform matching mechanisms makes it more difficult than it has to be for physicians to provide patients with suitable cells in a timely way," said Kristine Gebbie, associate professor of nursing and director of the Center for Health Policy and Doctoral Studies Columbia University, New York City, and chair of the committee that wrote the report.

"Moreover, there simply aren't enough units of cord blood available now to meet the needs of the roughly 11,700 Americans who could benefit from a transplant of these cells every year. The structure we are recommending for a national cord blood banking program would assure that patients receive high-quality therapeutic cells in the most timely, ethical and cost-effective manner possible," Gebbie said.

90% of Transplant Needs Could Be Met

Three-quarters of the patients who require a transplant of HPCs do not have a relative whose cells would be a suitable match and must turn to public bone marrow donor registries or umbilical cord blood banks for donated cells.

By increasing the size and quality of the cord blood inventory, nearly 90 percent of all patients who need a transplant should be able to find a suitable match from either cord blood banks or marrow donor registries, the report says.

The new National Cord Blood Policy Board should be established at the level of the office of the DHHS secretary to ensure that it is distanced from the day-to-day concerns of other parts of the department responsible for managing relationships with and funding for bone marrow donor programs and cord blood programs, the committee urged.

The board should routinely review the results of cord blood stem cell transplants and guide DHHS and the cord blood banking program on procedures and standards for banking and allocation, and on any changes to the inventory of cord blood units.

Decisions about which source of HPCs to tap must be made on a case-by-case basis and driven by the patient's needs, the report recommends. To that end, the board should actively encourage collaboration between marrow donor registries and cord blood banks, as well as support cord blood banking's emergence as a transplant option.

Inventory Expansion Top Priority

The majority of funding available for the national cord blood bank program should be targeted to expanding the inventories of participating banks.

Based on the current estimate that 50,000 useable units of cord blood are now available through public banks and the NMDP, the committee projects a need for at least 100,000 more high-quality units. The larger the inventory, the greater the likelihood that a patient will be matched to a suitable unit and receive an optimal dose of cells, although the costs of collecting and storing cord blood also must be considered.

Cord blood banks should strive to provide units with a high-enough concentration of stem cells to make up for imperfect matches between donor and recipient -- a frequent occurrence, the report notes. The more closely surface markers on donated cells match those on a patient's own cells, the less likely that the patient's body will reject the transplant.

For many racial and ethnic minority patients, it is difficult or impossible to find suitable matches because many cord blood collections are not ethnically and racially diverse.