Cord Blood Utilization is Booming in China

During the summer of 2023, Frances Verter accidentally discovered that the inventory of cord blood stored in China and the number of cord blood therapies performed there each year are much higher than is realized by most people in the west. This discovery was made simply by reading the websites of Chinese cord blood banks. Since then, with the help of Jamie Woon in Singapore and Lucy Lai in Hong Kong, we have put together this summary of cord blood usage in China.

Cord Blood Inventory

The total inventory of donated cord blood units (CBU) in China may be – at a conservative guess – about 500,000. Most Chinese banks do not reveal their inventory. Chinese regulations on cord blood banking have placed a limit on one licensed bank per province, and all licensed banks must be a hybrid combination of public and private banking¹. There are currently seven provinces with active licensed cord blood banks². There are also other businesses in China that are unofficially banking and transplanting cord blood under stem cell licenses. For example, Beike Biotech claims that their company alone has treated over 33,500 patients with a variety of cell therapies, including cord blood³.

We only have data on the inventory in a few of the cord blood banks in China. First, based on their 2022 annual report, there is a combined total of close to 100,000 public CBU in the banks of Beijing, Guangdong, and Zhejiang, that are owned by Global Cord Blood Corp².  Second, “as of the end of 2020, nearly 100,000 cases of allogeneic umbilical cord blood have been stored" in the Sincord cord blood bank in Shandong province⁴. Third, the Tianjin public cord blood bank claims an inventory of 200,000 as of mid-2023 (this makes Tianjin the world’s largest public cord blood bank)^5,6. Fourth and finally, it is reasonable to guess that the remaining biobanks in China that are banking cord blood either officially or unofficially contain at least another 100,000 donated CBU. This is why our conservative guess places the public inventory in China at half a million CBU. By comparison, the most recent 2022 annual report of the World Marrow Donor Association (WMDA) listed the public CBU inventory in China as 27,775, a tally which is too low by a factor of 18⁷.

Cord Blood Releases for Therapy

In the accompanying Table, we have summarized the cumulative number of CBU released for therapy from those Chinese cord blood banks that have provided this information on their websites or their social media accounts. In total, the numbers in this table add up to 34,133 cord blood therapy releases. This is not equivalent to the number of cord blood “transplants”. In a traditional cord blood transplant, the patient receives myeloablative chemotherapy and then has their immune system regenerated with cord blood alone. In China, stem cell transplants for malignancies often combine different types of graft sources, such as cord blood together with bone marrow, or a combination of autologous and allogeneic cord blood⁸. Many releases from Chinese banks are sibling transplants for non-malignant hemoglobinopathies^9,10. Plus, in China both autologous and allogeneic CBU are often released for clinical trials of regenerative medicine applications, such as osteoarthritis, stroke, and Alzheimer’s disease, among others⁵.

During the year 2020, six cord blood banks in China cumulatively released 4907 CBU for therapy, based on statements found in the news category of their websites. By comparison, the 2020 annual report from WMDA claimed that 1670 cord blood transplants had been supplied by banks in the entire continent of Asia, which includes all Asian countries as well as the geographic region that many consider the Middle East⁷.

The Chinese medical community holds an annual national cord blood conference. At their 10^th conference held 19-21 May 2023, it was announced: “It is understood that the application of umbilical cord blood has exceeded 85,000 cases worldwide, and the number of applications of umbilical cord blood in China has exceeded 30,000.” This statement was made by Professor Fang Jianpei, Chairman of the Cord Blood Application Committee of Guangdong Maternal and Child Health Care Association and Chief Physician of Pediatrics at Sun Yat-sen Memorial Hospital of Sun Yat-sen University¹¹.

WMDA Global Trends Only Display WMDA Members

Members of the cord blood industry have traditionally relied upon the World Marrow Donor Association (WMDA) to annually publish a Global Trends Report which includes, among other information, the number of cord blood units stored in public banks and the number of cord blood transplants during the past year⁷. The numbers from these annual reports are then quoted at conferences and in publications throughout the cord blood community. Based on this report, researchers in the west believe there are currently 830,000 cord blood donations in public banks and there have been 40,000 cord blood transplants to date^12,13. Those numbers are mostly accurate for the world outside China. The problem is that WMDA data happens to be very inaccurate inside China, and China happens to be the world’s most prolific country at banking and utilizing cord blood.

This article is not an attack on WMDA! Compiling an annual report on cord blood inventory and utilization is not part of the WMDA mission statement. The mission of the WMDA is to “work with our members to ensure reliable provision of life-saving cells while promoting care and safety for both patient and donor.” It is important to note that the content of the annual WMDA reports is completely dependent on contributions from members. At present, the WMDA only has one member cord blood bank in China, and the 2022 WMDA cord blood inventory for China is less than half the inventory they counted in 2014, when four banks in China contributed⁷. Those of us in the community that are relying on these reports as a snapshot of world affairs need to be more aware of their potential shortcomings.

Going forward, western scientists and medical doctors that have a vested interest in knowing world trends in cord blood utilization need to build better bridges to their counterparts in China. If we established a committee that was tasked to contact and interview representatives of all the stem cell banks in China, we might obtain an accurate total count of cord blood activities within China, and thereby more accurate global tallies.

References

1. Li Y, Verter F, Wang B, Gu N. Regulations on cell therapy products in China: a brief history and current status. Regenerative Medicine 14(8):791-803.
2. Global Cord Blood Corp. 2022 Annual Report aka SEC filing Form 20-F Published 2022-08-16
3. Beike Biotechnology. Beike Biotech: Stem Cell Provider and Research Institution. About. Accessed 2023-10-31
4. Sinocord. Cord blood bank notice Shandong Province Cord Blood Hematopoietic Stem Cell Bank Quality Announcement (2020). Blood bank news. Published 2021-02-05
5. Tianjin Cord Blood Hematopoietic Stem Cell Bank. Cord blood big data | Tianjin Cord Blood Bank added 24 cord blood application cases in August. Published 2023-09-26
6. Chen H. Stem cell translational medicine: The Tianjin model revisited. Stem Cells Transl Med. 2021; 10(Suppl 2):S4–S9.
7. WMDA. Global Trends Report. (requires membership) 2022 data published 2023-05-30
8. Jia Y, Li J, Tao H, et al. A Novel Hybrid Transplantation with Autologous Hematopoietic Stem Cells and Matched Unrelated Cord Blood Stem Cells Is Effective and Safe for Relapsed or Refractory Lymphoma: A Pilot Study. Blood 2019; 134(S1):5713.
9. Shi CY, Wei W, Lyu LJ, Wang Q. Umbilical cord blood application analysis of Guangdong Cord Blood Bank. Chinese Med J. 2020; 133(16):1997–1998.
10. Wu F, Shen JJ, Deng G. Reference Values of Umbilical Cord Blood Routine and Hemoglobin Capillary Electrophoresis in Newborns in Zhejiang Province and Their Significance in the Diagnosis of Hemoglobinopathy. J Clin Transfusion and Lab Med 2022; 24(2):239-243.
11. Beijing Jiachenhong Biotechnology Co., Ltd. The 10th Umbilical Cord Blood Conference of the China Maternal and Child Health Association was held in Guangzhou. Information Published 2023-05-22
12. Ballen KK, Verter F, Kurtzberg J. Umbilical cord blood donation: public or private? Nature Bone Marrow Transp 2015; 50:1271–1278.
13. Ballen K. Update on umbilical cord blood transplantation. F1000Res. 2017; 6:1556.