Banking on cord blood stem cells
Lim Siew May 
All parents want their offspring to live a long and healthy life. Can private cord blood banking help you with this goal? – 123RF

ALL parents want the best that money can buy for their bundle of joy. However, you also want to know that you are making an informed decision when investing in a gift of love for your offspring.

For some new parents, cord blood banking is one of those decisions. Cord blood banking involves collecting and storing your baby’s umbilical cord blood stem cells for potential medical use.

At StemLife Bhd, the first private cord blood stem cell bank in Malaysia that was established in 2001, the overall fees (initial investment plus annual storage costs) range from RM6,600 to RM19,000, depending on the types of technology, test and cell featured in the package, explains StemLife’s chief operating officer Zahrein Redza.

After storing the cord blood stem cells for 21 years, the young adult has three options as to what to do with them – donate them to his parents (parents to sign a new contract with StemLife), continue to keep them for himself (child to sign a new contract with StemLife) or disposing them.


Luxury or necessity?

There are two types of cord blood banks in Malaysia - the private cord blood bank and public cord blood bank.

With the availability of The Malaysian Public Cord Blood Bank located in the National Blood Centre or Pusat Darah Negara (PDN), is there a need for private cord blood banking, which requires parents to fork out huge sums for such services?

The National Blood Centre declines to comment when contacted. Meanwhile, associate professor Veera Sekaran Nadarajan, who is department transfusion medicine head at University Malaya Medical Centre (UMMC), explains that UMMC is not involved in commercial or voluntary cord blood storage.

“The transfusion medicine department has the stand that commercially available cord blood banking, where couples pay and save cord blood from their baby for later use, is less for treatment purpose. Usually, it is done in accordance with market demand, not medical requirements,” he explains.

“Voluntary cord blood storage as practised by National Blood Centre or other non-government organisations, where donations are voluntary and non-paid, however, should be encouraged and made available for the public when the need arises,” he adds.

Zahrein says StemLife’s clients, who cut across different social economic backgrounds, want the best for their children

StemLife’s Zahrein believes that cord blood banking serves its purpose. “The public or government cord blood bank openly said that cord blood banking is useful and needed. The government is pumping funds into it, in particular for blood-related disorders like thalassemia and leukaemia. They have a bank in PDN here [in KL], and also Sungai Petani, where they collect donated cord blood from the public from selected hospitals such as Hospital Kuala Lumpur [HKL],” he explains.


Individual decision

Opting for private cord blood banking is an individual decision that requires you to determine the level of service and protection you want for your family, he says.

“If you look at educational institutions and hospitals – you have public and private sectors. Both of them can co-exist. They support each other to provide a whole range of services to the population. Essentially, the government bank collects cord blood from parents who donate it to them, with no financial strings attached,” he explains.  

Zahrein says that StemLife’s clients, which cut across different social economic backgrounds, want the best for their children. They deem private cord blood banking a necessity and do not take chances. Some are even repeat clients who keep the cord blood stem cells for each child for enhanced matching rate, he points out.

“[The stem cells in public cord blood banking] can be used by anybody in Malaysia who needs them. If those parents, family members or their siblings [who donated to public cord blood banking] find that they need those stem cells, they can go back to government cord blood bank, but only if their stem cells are still there.

“They may have been used already, or there may be a long list of people already requesting for the stem cells. Meanwhile, for private cord blood banking, the family decides for themselves whether they want to store them to protect their own family members, children, siblings and parents themselves,” he adds.


Utilisation rate

The utilisation rate of cord blood stem cells gives one an indicator of the chances of actually using them in the future. Zahrein points out that 15 of its 60,000 clients, or one in 4,000 clients, have made use of the stem cells since the company was established.

He explains the utilisation rate is a lot higher in the grander scheme of things. “If we look at statistics - globally the estimates in the US are a lot higher – estimates in the US are anywhere between one in 100 to one in 500. That was the analysis done in 2007,” he says.

On the other hand, Datuk Dr Nor Ashikin Mokhtar, founder and executive chairman of PrimaNora Medical Centre, points out that the likelihood of using the cord blood stem cells is low.

She cites a report from the American Congress of Obstetricians and Gynaecologists in 2011 and 2013, which found that the lifetime probability of using stem cell transplant is one in 217 by the time one turns 70.

Dr Nor Ashikin believes early detection and prevention could be more effective

Zahrein argues that, essentially, storing cord blood is like buying an insurance protection plan. “We hope we don’t have to use it for diseases like leukaemia or blood cancer in future, but if it’s needed, it is lifesaving and fast.

“I don’t have to go to the public cord blood bank and ask. The matching rate at the public cord blood bank is not high - between 20,000 to 30,000 people have to be tested first to find one that matches mine,” he says. 

Zahrein points out that research on stem cells from cord blood, bone marrow and peripheral blood for general wellness is a booming field.

“[People are talking about using stem cells for] general wellness and health issues like joint, sports injury, ligament ... The field of beauty like anti-ageing and wellness is another big aspect of it.

“Essentially, even if you have no medically life-threatening diseases, later on, there are areas that you can potentially use your cord blood stem cells for. I am quite confident that during the 20-year storage, somebody will be using the stem cells – if not the parents, the children themselves will be using it for one of those areas mentioned above,” he points out.


Fast pace of medical development

One key contention to private cord blood banking is that the cost isn’t loose change to the common men, as attested by Dr Nor Ashikin. The uncertainty of what is going to happen some 20 years later (which is the storage duration) may accentuate the downside.

“Already, new medical development takes place like every split second. Whatever you think you’re doing now could be outdated 20 years later. There are so many researches on stem cell going on, this technology might be irrelevant in the future, and you would have put so much money into it all these years,” she says.

In addition, there may also be risks of contamination and mutation during the long storage duration, and the question of whether a private cord blood banking provider will still be around. 

“If you were to look at what is happening now – we can manage the treatment that they claim. I can still get adult stem cells [instead of cord blood stem cells stored for a long duration] to treat myself – I can either get them fresh from my fat cells, my own blood, or bone marrow, which is one of the earliest methods we use for stem cell transplant,” she points out. 

While Zahrein agrees that adults can harvest their own stem cells, he points out that the process of harvesting can be quite invasive, depending on the procedure you opt for. Besides, the quality of the stem cells may be in question at that stage.

“For instance, if one were to harvest stem cells from the bone marrow as an adult, the quality of cells may be less regenerative compared with those from the cord blood,” he says.


When it may be worthwhile

Dr Nor Ashikin concurs with the view of the transfusion medicine department at UMMC that storing one’s baby cord blood is not medically indicated. Rather, it’s just an option for you to consider.

As such, when does it make sense to go for this option? While a rare occurrence, she points out that if your baby is born premature, then maybe it’s worthwhile to consider storing your baby’s cord blood since premature babies run the risk of having brain damage like cerebral palsy. Mothers, she adds, can also use them for aesthetic reasons.

Similarly, if there’s a family history of neuro-degenerative disorders, and you believe that you can help your family members immediately as opposed to storing them for 20 years, then it is also a worthwhile consideration, she adds.

“That’s when you can use the cord blood stem cells immediately or early. However, if you want to store them, unless you have a crystal ball that the child might need them next time, then this is an option for you to consider,” she summarises.


Early detection and prevention

Another point raised by Dr Nor Ashikin is that we can all play a more proactive role in the health department. For instance, it is now possible to go one step ahead to detect potential health problems, rather than resorting to cord blood to treat diseases.

“Say you are going for in vitro fertilisation [IVF] – you can test the baby’s genes for diseases. You have the choice of not being pregnant with that child if he has potential disease, rather than going for cord blood banking,” she says.

She is also a firm believer that prevention is better than cure. “So, even if you’re born with cancer genes, say breast cancer, it doesn’t mean you will develop it. At the same time, it doesn’t mean you don’t have breast cancer genes – 15-20% is genetic, while about 85% is epigenetic.

“The cause of cancer is multi-factorial – you don’t know what triggers it, it could be factors like your diet, you eat too much processed food laden with all sorts of chemicals, drink carbonated drinks filled with chemicals that can cause a toxic look to your body. Genetically, if your liver cannot cope with the de-toxin process, that can contribute to abnormal cancer change,” she explains.


DNA profile test

A DNA profile test can help you in ways such as detecting specific genes for diseases, how your body produces antioxidant, whether you are at risk of high cholesterol and if the body has abnormal genes that cannot detox your body well.

“If you know you have inefficient or dysfunctional genes, supporting them with the right nutrients and supplements can make a difference – you can avoid the pathway of having cancer and be healthy,” says Dr Nor Ashikin.

If investment in private cord blood banking is merely a drop in the ocean for you, you can opt for it to better protect yourself from various health risks. But when you’re just getting by in life, you want to think through this option with particular care, she stresses.

“There is this emotional or fear factor when people think about buying this “insurance” [private cord blood banking]. They worry about what’s going to happen when their child has leukaemia, for instance. But they can prevent it from happening.

“Again, it’s not hereditary. Look at the root cause – look into the child’s nutrition and supplementation. Understand the risk factors, family history to improve the child’s wellbeing to prevent the child from having cancer, autism, attention
deficit hyperactivity disorder or depression,” she concludes.

Opting for the right cord blood bank

THERE are a number of private cord blood banks in the market. How do you go about choosing the right provider?

In Malaysia, there are three key players in the private cord blood banking space. StemLife Bhd chief operating officer Zahrein Redza points out that some new parents who decide on private cord blood banking may make the mistake of selecting “the first bank that comes along, depending on who is the cheapest.”

He believes that it’s wiser to look at a more holistic picture. “Essentially, you should look at the track record of the bank, transparency, prudency in using cells. We are talking about storing the cord blood for 20 over years. In the end, you want the bank to still be around when you call for it, with less hassle.

“You want a bank that has the highest experience in successfully releasing cord blood for diseases that are currently approved, such as leukaemia, thalassemia and blood disorders. These are the main concerns that the public needs to worry about,” he explains.

This article first appeared in Focus Malaysia Issue 259.