Care for the cord

Rahul Bhargava

For most of India, the umbilical cord is nothing more than a waste product of the birthing process. Left dangling from the newborn’s navel, it disintegrates and falls off on its own within a week. However, in the scientific world, it is a precious resource with immense regenerative and healing potential. A baby’s umbilical cord is a rich source of stem cells (10 times more than adult bone marrow), which, if properly extracted, screened and stored in a public blood bank, could be a saviour in many life-threatening conditions, including several forms of leukaemia, lymphoma and bone marrow disorders, not just for the baby or its siblings/parents, but more so for hundreds of others whose blood make-up matches with his.

More than 28 years after the first successful umbilical cord blood stem cell transplant was done in France, India is still to discover its vast potential and make provisions for public banking of this easily available precious resource. What we need is an organised public umbilical cord blood banking system in the country that can treat patients in need and be used for further medical research on the subject.

While bone marrow and peripheral blood stem cell transplants have a proven track record of success, the search process can be futile. Therefore, Umbilical Cord Blood (UCB) has gained popularity and acceptability as an alternative transplant source for patients lacking appropriate adult donors. UCB transplantation (UCBT) offers several advantages as compared to Bone Marrow (BM) or Peripheral Blood (PB). UCBT requires a 4/6 match as opposed to 6/6 match required for BM or PB. Also, UCB is easily collected and stored without causing any detriment to the quality of cells and is readily available when needed.

In India, the awareness of benefits of cord blood banking is just dawning. However, in the US, reputed medical groups such as the American Medical Association, the American Congress of Obstetricians and Gynecologists and the American Academy of Paediatrics recommend public bank donations over private banking because the cord blood has limited personal applications.

The chance of a baby benefiting from his or her own banked cord blood is currently less than 0.04 per cent, according to the ASBMT. Not only is that because the diseases currently treatable with cord blood are fairly rare, but with many, the child’s cord blood would be unusable because those stem cells contain the same genetic defects.

India has a great potential for UCB banking due to a high birth rate and genetic diversity. Nearly 70 per cent of patients requiring bone marrow transplantation do not find a match within their own family. Hence, unrelated UCB is a widely accepted source of progenitors for hematopoietic stem cell transplantation. However, to date, the total number of UCB transplants performed in India has been very low, mainly due to high cost and the limited number of UCB units available against the estimated requirement of 50,000 units annually. With the establishment of public banks, the utility of UCB is likely to increase in the coming years. For cord blood bank to be effective, it should have at least 50,000 units and it shall then be able to provide a matched cord for 98 per cent of its patients.

To meet the future transplant needs of India, government support and investment is necessary. For the past 30 years, the governments in India have ignored the desperate need of providing treatment to their citizens with fatal blood related disorders. However, recently Prime Minister Narendra Modi brought to the notice of the Parliament the plight of a tribal suffering from sickle cell disease, a condition treatable by UCBT.

The writer is director and head, Hemato-oncology and Stem Cell Transplant, Artemis Hospital, Gurgaon