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Statistics of Autologous Cord Blood Storage and Use

Statistics of Autologous Cord Blood Storage and Use. J.J. Nietfeld, Ph.D. University Medical Center Utrecht, The Netherlands Frances Verter, Ph.D. www.ParentsGuideCordBlood.com. Contents. Introduction to authors Review of cord blood industry Inventory of stored cord blood in USA

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Statistics of Autologous Cord Blood Storage and Use

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  1. Statistics of AutologousCord Blood Storage and Use J.J. Nietfeld, Ph.D. University Medical Center Utrecht, The Netherlands Frances Verter, Ph.D. www.ParentsGuideCordBlood.com Nietfeld & Verter

  2. Contents • Introduction to authors • Review of cord blood industry • Inventory of stored cord blood in USA • Previous opinions and estimates re usage • Calculate lifetime probability of autologous transplant • Forecast lifetime probability of autologous use for regenerative medicine • Implications Nietfeld & Verter

  3. J.J. Nietfeld, Ph.D., Biography • Biochemist & Pathobiologist • Associate Professor, UMC Utrecht, The Netherlands • P.I. 2003 ZonMw report: “Desirability and feasability of a Personal Cell Bank” Netherlands Report proposes 3-way split of stored cord blood: 1- private portion 2- public portion 3- research portion Nietfeld & Verter

  4. Nietfeld & Verter

  5. ParentsGuideCordBlood.com • Mission Statement: Impartial review of cord blood storage options Nietfeld & Verter

  6. Website Readership 67,494 = 36.03 % .net 38,656 = 23.51 % .com 38,590 = 21.20 % (numerical IP) 3,837 = 2.85 % .br (Brazil) 4,338 = 2.81 % .edu (USA Edu) 1,930 = 1.24 % .org (Non-Profits) 2,140 = 1.19 % .de (Germany) 1,938 = 1.06 % .ca (Canada) 1,942 = 1.05 % .au (Australia) 2,468 = 1.03 % .mx (Mexico) 14,716 = 8.03 % ALL OTHERS • Hits from over 70 foreign countries in the past month • Average monthly hits over past year: 158,933 Nietfeld & Verter

  7. Types of Cord Blood Banks Nietfeld & Verter

  8. USA Cord Blood Inventory Nietfeld & Verter

  9. Investments in CB Banking Nietfeld & Verter

  10. Previous Opinions Against Autologous Cord Blood Banking • American College of Ob and Gyn (ACOG) 1997; Int J Gyn Ob, 58(2):257-259 • American Academy of Pediatrics July 1999; Pediatrics, 104:116-118 • Royal College of Ob and Gyn Oct. 2001; Opinion Paper 2 • European Group on Ethics in Science and New Technologies March 2004; Opinion No.19 Nietfeld & Verter

  11. Previously Published Chancesfor Autologous Transplant Use • 74 : 200,000 (< 20 yrs) F.L. Johnson, 1997; J Ped Hem Onc 19(3): 183-186. (based on statistics of diseases and treatments) • 1 : 20,000 ( < 20 yrs) G.J. Annas, 1999; NEJM 340: 1521-1524. (not substantiated) • 1 : 10,000 – 1 : 200,000 (lifetime) R.M. Kline, April 2001; Sci Amer 4: 30-37. (not substantiated) Nietfeld & Verter

  12. Lifetime storage of Cord Blood:source of autologous stem cells • At – 196 °C it takes thousands of years for • cosmic radiation to damage cells • Cord Blood Transplants on adults have been successful in clinical trials • Numerous companies are “expanding” cord blood cell counts • Current research focus is speeding cord blood engraftment Nietfeld & Verter

  13. Probability of an autologous transplant during one’s lifetime The probability P depends on a formula which the authors wish to reserve until it is published. P is a function of n and p Where: n = maximum age for treatment p = probability / year of autologous transplant Nietfeld & Verter

  14. Data for North America 2002 Nietfeld & Verter

  15. Autologous Transplant Lifetime Odds: North America 2002 ProbabilityP = 0.25% Using n = maximum age for treatment = 70 p = probability / year of autologous transplant = (# autol. transplants per year) / (population < 70) = (10,500)/(290 million) Nietfeld & Verter

  16. Autologous Transplant Lifetime Chances up to age 70 Chance in % Nietfeld & Verter

  17. Forecast of cord blood use for regenerative medicine • Given long “shelf life” of cord blood, today’s babies can use autologous cord blood for future regenerative medicine • Auto CB carries advantages over Auto BM: • Stem cells have more “plasticity” (under study) • No surgical harvest • Lower cost (depending on storage time) • Lifetime probability of diagnosis gives an UPPER LIMIT for treatment Nietfeld & Verter

  18. Example: autologous stem cells for Cellular Cardiomyoplasty ie: stem cell transplantation for cardiac repair. Indications: Myocardial Infarction, Congestive Heart Failure Nietfeld & Verter

  19. Nietfeld & Verter

  20. Cellular Cardiomyoplasty Lifetime Odds: USA 2001 Probability P = 14% Example: USA inpatient PCI up to age n=75 Yearly rate p = (571,000/ 264,818,014) = 0.002 (Ref: American Heart Association Statistics) Nietfeld & Verter

  21. Probability per Lifetime Autologous transplant or Diagnosis Nietfeld & Verter

  22. Implications • Autologous cord blood storage outnumbers public donations and is growing faster. • USA National Cord Blood Program will invest less $$ towards growth than private companies. • Correct probability of autologous stem cell use is much higher than standard assumptions. • Regenerative medicine dramatically increases opportunities for autologous use of stem cells. • Private cord blood banking is here to stay. Nietfeld & Verter

  23. Future: harness private inventory for public good? • Need 150,000 CB for all USA transplants (Ref: Pablo Rubinstein, M.D., NYBC) • Private banks will add that much to inventory in less than 2 years. • Instead of the USA government funding a program of public banks --- • Why not offer parents in private banks a REGISTRY OPTION? (with quality standards) Nietfeld & Verter

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