Storage of cord blood hematopoietic stem cells

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; REGUEIRO, A.; GARCIA MARTI, S.; GLUJOVSKY, D.; BARDACH, A.

Documentos de Evaluación de Tecnologías Sanitarias

IECS

Año: 2004 p. 1 - 30

1668-2793

The aim of this study was to assess the usefulness of cord blood stem cell storage for: 1) Future potential use by the person who has just been born but does not suffer any current pathology, 2) use by a third party who suffers one of the pathologies which benefit from conventional bone marrow transplantation (leukemia, lymphoma, some central nervous system tumors, hemoglobinopathies, aplastic anemia and other diseases related to genetic disorders such as metabolic disorders).A bibliographic search was carried out on the main databases (MEDLINE, Cochrane, DARE, NHS EED), in general Internet search engines, in Health Technology Assessment agencies and health providers, using the following key words: Cord Blood Stem Cell Transplantation. Priority was given to the inclusion of systematic revisions; controlled, randomized clinical trials; health technology assessment reports and economic evaluations; clinical practice guidelines and coverage policies of other health systems. Information was taken from local sources on the use of sanitary resources, costs and coverage in Argentina.The different coverage policies and opinions of the scientific associations found, including the Asociacion Argentina de Hemoterapia e Inmunohematologia (Argentine Society on Hemotherapy and Immunohematology), support the storage for those cases in which there is a currently sick relative who might specifically benefit from its use (in general, the same indications as for conventional bone marrow transplantation). However, the storage is not recommended for later use of the person who has just been born, for non-defined future potential purposes. This potential use is not included in the coverage policy provided by the analysed health systems.In the systematic review, its use was assessed as an alternative to conventional bone marrow transplantation. Among the studies included, there were very few which included control groups, were not randomized and compared the use of cord blood cells and the bone marrow cells. After adjustment for baseline differences, a lower incidence of graft versus host disease was noted in the cord blood stem cell group (reducing it approximately by half), although there were no differences in the rate of cellular clone recovery (neutrophils and platelets), nor in the mortality between the two groups three years after transplantation.At present, in Argentina, the harvesting and storage of cells in private banks cost about $900 (U.S. dollars, 2004) during the first year and $90 every following year.