Last week in the Singapore Straits Times, there were two snippets about cord blood stem cell banking. The first one was a news piece on the Singapore public cord blood bank (entitled Cord Blood Bank has saved 21 lives**) which was campaigning for an increase in units (arguably an ad in itself). The other snippet was an ad by a local private Singapore Cord Blood Bank Cordlife. The ad appeared 2 days after the news article and I don't think its a coincidence to keep the conversation and interest in Singaporean's minds.
The first article from the Singapore Cord Blood Bank at a press conference reveals quite a lot about what its like to be an operator of a public bank:
How many cord blood stem cell units have been released and where have they gone?
"In the 3 years it has been open, the Singapore Cord Blood Bank has saved 21 lives - here and overseas... a 22nd donation was winging its way over to France"
"Of the 21 recipients, 12 were patients here while the other nine were ethnic Asians in Europe and Malaysia."
Comment: 21 cord blood units utilized in transplantation is very respectable for a small bank. Financially, at a purchase price of SGD 26,000 per unit in Singapore, the SCBB would have generated SGD 312,000 in revenue for the 12 Singaporean patients and another approximately SGD 320,000 from the 9 overseas patients (assumption is that these patients came through the NMDP network and paid the standard price). That would bring the SCBB's total revenue to SGD 632,000 or slightly more than this.
How many Singaporeans have donated cord blood and how many of those have been successfully banked?
"The repository has been able to bank about half of the 9,000 donations so far. Donations sometimes do not yield enough stem cells to be viable*."
Comment: The yield of 50% is very much in line with what I've heard from other public cord blood banks. However the article doesn't explain that units are discarded due to bacterial / viral contamination (let's not forget that vaginal flora and fauna can be quite substantial) and that the cord blood bank sets its own guidelines as to the volume and/ or cell count required at the beginning before they proceed to process the unit.
As a guide, at the time of receipt of the cord blood unit, most public cord blood banks insist on a minimum volume of 100 mls or total cell counts exceeding 1 billion. The rationale for this is that the cord blood unit needs to be at a level high enough to treat an adult (including caucasian weight & bigger sized asians), otherwise its not worth keeping (bearing in mind that this inventory can and most certainly will take years to clear). *Thus the term "viable" in the article refers to the unit's chances of being used.
Targets for the Singapore Cord Blood Bank?
"An earlier target of banking 10,000 samples by next year has been extended to 2013 said Mr. Sobak (SCBB's CEO and COO of SingHealth), since its been harder to get good-quality donations."
Comment: 10,000 units in the tank is an ambitious target but let's consider the following points:
1) The SCBB is based in the KK Women's and Children's Hospital, which alone delivers the vast majority of Singaporean babies has handled almost 40,000 babies at its peak, but more likely in the range of fifteen to twenty thousand now.
If the SCBB were able to collect all of the cord blood units from all the babies delivered there per year, without approaching any other hospitals (and discounting the 50%) the SCBB would have had about twenty thousand or so units by now. But, that would mean that they would have been working at a pace of 20 units per day seven days a week, all year round for 3 years. Hence the limitation of time, processing space and cost all plays a part in the operational capacity. [4 years more for 5000 units]
2) Cordlife, the first local Singaporean private cord blood bank started in 2001 only recently achieved 13,000 units in 2008 (announced in an ad) and claim only a 1% contamination rate, which means that they store almost every unit they receive. So repositories take a long time to build. [7 years for 13,000 units]
3) StemLife achieved 10,000 units in 2006, about 4 years after operational commencement (I assure you, not without toil).
Another target mentioned by the CEO was 30 transplants for the financial year 2009. I find this to be an interesting target, as I suspect it greatly depend on whether the requests just happen to match the units in the tank? Or perhaps it is now possible to analyze the recipient population and to try to identify the relevant donors to collect the cord blood from.
Anyway, getting back to the financial year for SCBB, I suppose the financial target would be in excess of SGD 1 million in revenue - if they manage to sell the inventory overseas. It is a business after all.
What are the likelihoods of use?
"At least six people are diagnosed daily in Singapore with different types of blood-related diseases said the bank's medical director William Hwang."
"Many of these patients will require a blood stem cell transplant to survive"
"With these samples and those fom banks worldwide, the odds of local patients finding a match is about 10-20%"
OK, quick back of the envelope calculation here. 6 people diagnosed daily in Singapore with a blood related disorder, ie 2000+ people. Let's say 50% will require a transplant at some stage, so let's bring the figure to about 1000 people needing a transplant.
And since only 10-20% will be able to find a match from all available units locally and internationally, ie 100-200 people will get their stem cell treatment... and the rest will have to wait.
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