Arizona

AZ, United States

Arizona has state legislation around cord blood education that follows the Institute of Medicine guidelines and mandates/encourages physicians to educate expectant parents about ALL forms of cord blood banking.  The Arizona bill was enacted 26 Jan. 2006 and became 1 Jan. 2007.

FAQs

What questions should parents ask a Family Bank about Prices?
  • Is the enrollment fee charged once per family, or for each birth?
  • Is the first year of storage included in the processing fee?
  • Is the storage fee guaranteed fixed?
  • Are there any coupons currently available?  Most banks are constantly running a "special limited time offer".
  • Are there any professional discounts?  Most banks offer discounts to medical professionals and military personnel.  Some banks have discounts for first responders or students.  It pays to shop for these deals.
  • Do parents have the option of a partial or full refund if they decide not to store the cord blood for any reason?  For example, if the lab tests show contamination and the cord blood should not be saved, what happens?  Full refunds are typically only offered in situations where the bank provided staff to perform the collection service.
  • Should the family ever need the cord blood, check that the bank does not charge to release it.
What questions should parents ask a Family Bank about Laboratory Standards?
  • Is the cord blood laboratory accredited by an agency that has specific standards for cord blood banks and conducts inspections? (ex: AABB, FACT, ISO)
  • Some US states license cord blood banks (CA, MD, NJ, NY): Do they operate in those states?  Note that the California Biologics License is based on AABB accreditation, but lags behind the latest AABB updates.
  • Does the lab process cord blood around the clock, or only on selected shifts?
  • What tests does the lab perform on maternal blood?  
  • What tests does the lab perform for infectious disease markers?
  • What tests does the lab perform for contamination?
  • Does the lab ever reject cord blood collections on the basis of the tests of maternal blood, infectious diseases, or contamination? 
  • Does the lab maintain a "quarantine tank" for the storage of blood that might be able to transmit an infection?
  • What tests does the lab perform to measure the stem cell count of the processed cord blood and the stem cell viability?
  • Does the lab/bank inform parents, prior to storage, if the collection is too small for a transplant, and give them the option not to save it?
  • Does the lab/bank offer parents a refund if the cord blood collection has certain problems (contamination, low volume)?  These refunds are typically only offered if the bank performed the collection as part of their service.
  • What information will parents receive in the final report about their stored cord blood?
Are related donors better for transplants?
The overall answer is yes, but this is a complex topic.

The two important measures of patient outcome are: long-term survival, and the  impact on quality of life from graft-versus-host disease (GvHD). Sibling donors tend to trigger less GvHD.  Also, sibling donors are available faster than searching for an unrelated donor, and patients have better survival when they go to transplant faster after diagnosis.

The exact comparison of outcome between sibling or unrelated donor varies with the patient diagnosis.  The NMDP website has a page on this, with numerous references.  For many cancers the outcomes are comparable, although sibling donors have a slight edge. The largest study was by Weisdorf et al. 2002, for over 2900 patients with CML leukemia.  When correcting for all other factors, the survival with sibling donor vs unrelated donor was 68% vs. 61%. Sibling donors show a significant improvement for pediatric cord blood transplants of hereditary disorders.  The European Blood and Marrow Transplantation Group (EBMT) reported 3 year survival rates of 95% from a sibling donor vs. 61% from an unrelated donor.

References:
Weisdorf, D.J. et al. Blood 2002; 99:1971-1977.
Bizzetto, R. et al. (EBMT) Haematologica 2011; 96(01):134-141

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