New Delhi ,
It was the year 1988 when the first umbilical cord blood (UCB) transplantation (UCBT) was performed in France, and since then the procedure gained massive acceptance as an effective treatment modality for various malignant and non- malignant blood-related (haematological) disorders.
In fact, studies suggest that in the treatment of Leukaemia, UCBT might have an edge over conventional Bone Marrow Transplant (BMT). A study published in the year 2016, in The New England Journal of Medicine, showed that those leukaemia patients who received a cord blood transplant "had good outcomes with low relapse rate" compared to those who received stem cells from an adult, unrelated donor 1.
Such findings are significant, especially considering the high prevalence of blood-related disorders in the country that need to be addressed timely and effectively.
According to estimates, 20 million carriers and 10,000 children taking birth each year with Thalassemia. It is projected that in the year 2020, the number of Thalassemia cases will rise up to 132,574. Other blood-related disorders like, aplastic anaemia and sickle cell anaemia, are also fairly common in the country. Especially sickle cell anaemia, which is so prevalent in the tribal population of India that recently Prime Minister Narendra Modi pointed out the issue in the parliament as well.
“Giving the scenario, the country is undeniably reeling under the huge burden of haematological disorders, and therefore, findings which highlight the efficacy of UCB transplant should definitely be taken seriously,” says Lalit Jaiswal director of CelluGen.
Why public cord blood banks?
While cord blood banking has gained much acceptance in recent times, most people don’t know the difference between private and public cord blood banking and which one is better. According to experts, private cord blood banking, which is basically meant for self-use is of very little medical application because in most blood-related disorders UCBT is recommended to be that of another person (allogeneic) and not your own (autologous), as the genes which caused the disorder are already present in the cord blood.
For this, CelluGen, a Government of India licenced cord blood bank is making inroads in helping parents treat their children by privately banking the cord blood unit for therapeutic application in a Pool bank. Their verticals, Mycord will bridge the gap of finding a compatible cord blood unit for transplant at no additional procurement cost.
Mr Lalit Jaiswal says, “By making the availability of cord blood a possibility we have taken the initiative of redefining the private umbilical cord blood banking in the country. But to build a large pool of UCB units in the public domain, the stakeholders, government agencies and the public at large have to collectively come forward.”
ICMR guidelines of 2007 & 2012 also states, “Use of stored umbilical cord blood for self-use is practically nil” and in the 2017 guideline, it further adds, “So far there is no scientific basis for preservation of cord blood for future self-use and this practice, therefore, raises ethical and social concerns.”
This is the exact reason why despite having such tremendous treatment potential, with just 3 public banks collectively storing only 5,000 units, UCBT in India is still scarce. Till date, only 32 patients have received a transplant using related or unrelated UCB in India as compared to tens of thousands being performed in the developed countries.
With the launch of Ayushman Bharat, a GOI initiative, the country is about to take a leap in healthcare wherein even the marginalised section of society will be able to avail high-end treatment. However, to treat patients with blood-related diseases, procurement of the cord blood unit, both in terms of availability and cost has to be addressed. For this, we need to develop our own pool of UCB units to find HLA (immunological) matched UCBs for the patients.
India has a high birth rate of 26 million births per year with a genetically diverse population. This could possibly position our country as the largest pool of genetically diverse UCB units in the world and thereby saving many from crippling haematological disorders.
Cord-Blood Transplantation in Patients with Minimal Residual Disease. New England Journal of Medicine, 2016; 375 (10): 944 DOI: 10.1056/NEJMoa1602074