Devine, et al. (2003). Clinical application of hematopoietic progenitor cell expansion: current status and future prospects.

[Wise Young]

• Devine SM, Lazarus HM and Emerson SG (2003). Clinical application of hematopoietic progenitor cell expansion: current status and future prospects. Bone Marrow Transplant 31:241-52. Summary: In the past decade, we have witnessed significant advances in ex vivo hematopoietic stem cell culture expansion, progressing to the point where clinical trials are being designed and conducted. Preclinical milestone investigations provided data to enable expansion of portions of hematopoietic grafts in a clinical setting, indicating safety and feasibility of this approach. Data derived from current clinical trials indicate successful reconstitution of hematopoiesis after myeloablative chemoradiotherapy using infusion of ex vivo-expanded perfusion cultures. Future avenues of exploration will focus upon refining preclinical and clinical studies in which cocktails of available cytokines, novel molecules and sophisticated expansion systems will explore expansion of blood, marrow and umbilical cord blood cells.Bone Marrow Transplantation (2003) 31, 241-252. doi:10.1038/sj.bmt.1703813.

[larwatson]

Dr. Young,

What role does the Red Cross play in supplying bone marrow and umbilical cord blood to researchers? In addition, I was recently told that the Red Cross itself actually has processes in place regarding the harvesting of stem cells. Is this correct?

[Wise Young]

larwatson, many of the traditional blood banks have taken on the task of becoming the bone marrow and umbilical cord blood banks as well. For example, the New York Blood Bank is the largest repository of bone marrow and umbilical cord blood in the United States, I think. In any case, these public banks are much better than the "Mom-and-Pop" operations that have sprung up all over the United States to provide "private" banking for people who want to save their babies' umbilical cord blood. A number of organizations have come out fairly strongly against this practice because there is not very good evidence that umbilical cord blood (or any type of cells) can be kept for many decades and it is highly likely that 20-30 years from now, we will not need to rely on umbilical cord blood as a source of cells for repairing the body. I also think that most of the companies that do private blood banking do not have the financial resources to assure multi-decade storage of the blood cells.

The economics of these banks are very interesting. The "public" banks put their repositories on internet where people desirous of matched blood can search. However, the larger your collection and the longer you keep the blood, the more expensive it becomes. Thus, for example, a unit of matched umbilical cord blood currently costs about $15,000, even though it costed only $2000 to process and about $600 per year to keep. The umbilical cord blood banks also have to meet very rigorous quality criteria (imagine the lawsuits if a single unit of blood with AIDS or hepatitis were to slip through). To make ends meet, the blood banks have to charge this much. There are probably about 100,000 umbilical cord units in storage around the world and perhaps half of this amount of bone marrow cells. Since the Red Cross has long played a role in blood banking, many of the non-profit banks are associated with the Red Cross. Stemcyte is perhaps the largest company that is involved in public umbilical cord blood banking.

Wise.