美国妇产科协会关于脐带血库专家意见——Umbilical Cord Blood Banking

VOL.126,NO.6,DECEMBER2015OBSTETRICS&GYNECOLOGYe127UmbilicalCordBloodBankingABSTRACT:Onceconsideredawasteproductthatwasdiscardedwiththeplacenta,umbilicalcordbloodisnowknowntocontainpotentiallylife-savinghematopoieticstemcells.Whenusedinhematopoieticstemcelltransplantation,umbilicalcordbloodoffersseveraldistinctadvantagesoverbonemarroworperipheralstemcells.However,umbilicalcordbloodcollectionisnotpartofroutineobstetriccareandisnotmedicallyindicated.Umbilicalcordbloodcollectionshouldnotcompromiseobstetricorneonatalcareoralterroutinepracticeforthetimingofumbilicalcordclamping.Ifapatientrequestsinformationonumbilicalcordbloodbanking,balancedandaccurateinformationregardingtheadvantagesanddisadvantagesofpublicandprivateumbilicalcordbloodbank-ingshouldbeprovided.Theroutinestorageofumbilicalcordbloodas“biologicinsurance”againstfuturediseaseisnotrecommended.RecommendationsTheAmericanCollegeofObstetriciansandGynecologistsmakesthefollowingrecommendationsregardingumbili-calcordbloodbanking:•Umbilicalcordbloodcollectionshouldnotcom-promiseobstetricorneonatalcareoralterroutinepracticeforthetimingofumbilicalcordclamping.•Ifapatientrequestsinformationonumbilicalcordbloodbanking,balancedandaccurateinformationregardingtheadvantagesanddisadvantagesofpublicandprivateumbilicalcordbloodbankingshouldbeprovided.•Thecurrentindicationsforcordbloodtransplantarelimitedtoselectgenetic,hematologic,andmalignantdisorders.•Patientsshouldbeawarethatincertaininstances,useofone’sownstemcellsiscontraindicated.Mostconditionspotentiallytreatedbyapatient’sownumbilicalcordbloodalreadyexistinhisorherowncellsand,therefore,thestoredbloodcannotbeusedtotreatthesameindividual.•Counselingshouldincludedisclosurethatthechanceachildorfamilymemberdevelopsaconditionthatcouldbetreatedwithanautologoustransfusionofumbilicalbloodisrare.•Theroutinestorageofumbilicalcordbloodas“bio-logicinsurance”againstfuturediseaseisnotrecom-mended.•Directedcordbloodbankingisavailablethroughprivateandpublicumbilicalcordbloodbanksforanypregnantpatientwhohasafamilymemberwithadiseasepotentiallytreatedbyhematopoieticstemcelltransplant.•Somestateshavepassedlegislationrequiringphysi-cianstoinformtheirpatientsaboutumbilicalcordbloodbankingoptions.Obstetrician–gynecologistsandotherobstetriccareprovidersshouldconsulttheirstatemedicalassociationsformoreinformationregardingstatelaws.•Asavarietyofcircumstancesmayariseduringtheprocessoflaboranddeliverythatmayprecludeadequatecollection,itisimportanttoobtainwell-documentedinformedconsentthatvariousmedicalCOMMITTEEOPINIONNumber648•December2015(ReplacesCommitteeOpinionNumber399,February2008)CommitteeonGeneticsCommitteeonObstetricPracticeThisdocumentreflectsemergingclinicalandscientificadvancesasofthedateissuedandissubjecttochange.Theinformationshouldnotbeconstruedasdictatinganexclusivecourseoftreatmentorproceduretobefollowed.TheAmericanCollegeofObstetriciansandGynecologistsWOMEN’SHEALTHCAREPHYSICIANSCopyrightªbyTheAmericanCollegeofObstetriciansandGynecologists.PublishedbyWoltersKluwerHealth,Inc.Unauthorizedreproductionofthisarticleisprohibited.e128CommitteeOpinionUmbilicalCordBloodBankingOBSTETRICS&GYNECOLOGYcircumstancesofthemotherortheneonatemaypreventumbilicalcordbloodcollection.•Physiciansorotherprofessionalswhorecruitpreg-nantwomenandtheirfamiliesforfor-profitumbili-calcordbloodbankingshoulddiscloseanyfinancialinterestsorotherpotentialconflictsofinterest.IntroductionOnceconsideredawasteproductthatwasdiscardedwiththeplacenta,umbilicalcordbloodisnowknowntocontainpotentiallylife-savinghematopoieticstemcells.Whenusedinhematopoieticstemcelltransplantation,umbilicalcordbloodoffersseveraldistinctadvantagesoverbonemarroworperipheralstemcells.Biologically,agreaterdegreeofhumanleukocyteantigenmismatchistoleratedbytherecipientandtheincidenceofacutegraft-versus-hostreactionisdecreasedwhenumbilicalcordbloodisusedcomparedwithunrelateddonorbonemarrow(1,2).Thepredominantdisadvantageofumbili-calcordblooduseisthatthereisoftenalowyieldofstemcellsacquiredperunit.Only8–12%ofumbilicalcordbloodunitshavesufficientcellvolumefortransplanttoapersonweighing80kg(176lb)(3).However,theuseofcombinedunitsofumbilicalcordbloodallowsfortheexpansionofumbilicalcordbloodvolume(andincreasednumberofstemcells)tobeusedforadulthematopoi-etictransplants.Sincethefirstsuccessfulumbilicalcordbloodtransplantin1988,ithasbeenestimatedthatmorethan30,000transplantshavebeenperformedinchildrenandadultsforthecorrectionofinbornerrorsofmetabolism,hematopoieticmalignancies,andgeneticdisordersofthebloodandimmunesystem(4).Umbilicalcordbloodstemcellsalsoarebeingstudiedintheareasofregenerativemedicineandinfectiousdisease().PublicVersusPrivateUmbilicalCordBloodBankingTwotypesofbankshaveemergedforthecollectionandstorageofumbilicalcordblood:1)publicbanksand2)privatebanks.ThefirstpublicbankwasestablishedattheNewYorkBloodCenterin1991andotherpublicbankshavesincebeenestablishedinvariousregionsofthecountry.InDecember2005,federallegislation,theC.W.BillYoungCellTransplantationAct,wasenactedth