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A Fast - Changing Scenario

It is estimated that in near future even Indian patients could find a well matched cord blood unit within these large registries

The knowledge of biological cell transplants for treating various diseases has been around for some time.  For this, stem cells can be sourced from various human tissues such as bone marrow, peripheral blood or the umbilical cord blood. Among these the umbilical cord blood is the easiest to source as it can be collected safely, swiftly, and preserved for a lifetime of use. These cells are also easier to match between donor and patient as they are newborn in nature and immunologically naive.

Stem cells, the master cells that help form organs and tissues and hence hold vast potential to treat human ailments, from umbilical cord are cynosure in 50 per cent of paediatric transplants and 22 per cent of all transplants. In the past 25 years, over 30,000 umbilical cord stem cells have been used at transplant centres across the world.

However, the efficacy of these transplants can be derived only through large scale studies done on multi-centre transplant data. The Centre for International Bone Marrow Transplant Research (CIBMTR) produces a highly detailed report on Survival Statistics that describes the use and outcome of autologous and allogeneic hematopoietic cell (HCT) transplantation in more than 500 centres that have participated in the CIBMTR.

The ongoing research worldwide currently aims to extend the use beyond the already established use of such transplants to treat blood related ailments as it is needed to treat tissues that need repair due to ageing or injury, such as in orthopaedic, cardiac, and diabetes. With 500-plus ongoing clinical trials, of which many are in advanced stages, these may become routine treatments in the near future. However, as per current ICMR guidelines to control the abuse, these treatments cannot be commercialised and must be done as registered trials with prior authorisation.

But patients who have an urgent need today and have exhausted all alternative options are seeking unapproved access to such experimental treatments. Lack of regulatory enforcement has further led to proliferation of such procedures by various institutions, which even use advertising to promote their services.

While umbilical cord blood has great potential, there are certain critical factors that still limit the much needed progress in this area. They include: (a) insufficient banked units that limit  the probability of finding a match (b) the cost of procurement of stem cells (up to Rs 20 lakh) due to lack of government policy support and (c) the lower number of stem cells obtained per umbilical cord, which may not be sufficient to treat adults.

However, this scenario is fast changing as the recent shift to community banking instantly transforms the inventory and cost situation. It is estimated that in the near future even Indian patients could find a well matched cord blood unit within these large registries and families who have preserved their baby’s stem cells will be able to withdraw matching units for free.

Further, clinical advancements to vastly multiply (over 100 -fold) the stem cells from the preserved umbilical cord have gained traction and success of these trials will mean that even adult patients will have sufficient quantity of stem cells for treatment.

The data from these trials have been so compelling that the FDA has designated them with “breakthrough” status and are fast-tracking their progress.

Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.



Chirayu Padhiar

The author is Senior Medical Director, LifeCell International

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