Umbilical Cord Blood

David Burrowes Excerpts

Monday 31st January 2011 Commons Chamber

[Mr David Burrowes (Enfield, Southgate) (Con)]

I am pleased to have secured this vital debate. At first sight, a debate about umbilical cord blood might seem highly specialised and marginal in terms of its interest and application, but I hope that the debate that I have initiated will highlight the importance of the issue, and its wide application to the saving of lives and money. We have just completed the Second Reading of the Health and Social Care Bill, and this debate chimes with the Government’s policy of creating a modern health service that is open to innovation and excellence, providing life-saving treatments.

I described this as a vital debate. “Vital” is a word used commonly in the Chamber. In fact, a quick search of Hansard will reveal that it was used 2,997 times in 2010—that is, an average of about 20 times each sitting day. It has been used in connection with banking reform, the G20, libraries and ladybirds. While all those are no doubt crucial subjects and worthy of parliamentary attention, my use of the word “vital” in this debate relates to the number of people who, sadly, die each year from blood disorders and cancers without the vital resource of umbilical cord blood.

I introduced the issue of umbilical cord blood to the House on 8 January 2008 through a private Member’s Bill on the subject. A number of hon. Members approached me afterwards, in a state of ignorance to which they openly confessed, to ask what it was all about. Since then the issue has been raised on a number of occasions—notably the debates on the Bill that became the Human Fertilisation and Embryology Act 2008—and great progress has been made in raising parliamentary awareness of the benefits that these life-saving cords can provide for people suffering from tragic illnesses. In 2008 an all-party parliamentary group was established, and I see that its chair, the hon. Member for Alyn and Deeside (Mark Tami), is present. I am sure that the House will wish to join me in paying tribute to the work of organisations such as the Anthony Nolan Trust, whose efforts have helped to keep the importance of cord blood at the forefront of the minds of many hon. Members, including Ministers.

I hope that tonight’s debate will remind Members of the value of this vital resource. Blood cancers are killers. According to Cancer Research UK, 4,000 new myeloma cases are diagnosed each year in Britain, and 2,500 myeloma sufferers die. There are 11,000 lymphoma diagnoses each year and 4,000 deaths; there are 7,000 leukaemia diagnoses each year and 4,000 deaths. For many sufferers, the only hope is a blood stem cell transplant. It may result from a bone marrow match, or from the taking of blood cells from the bloodstream of an adult donor or an umbilical cord donated by a mother after childbirth.

The procedure is complex, and there can be a range of complications that pose a threat to the patient. However, although it may seem awful that only 50% of blood transplant patients survive the treatment, almost none would survive without it. Blood stem cell transplants really are the last chance for people to whom no other treatment is available. For some of those people, a transplant is not just a treatment that saves their lives for a while, but an outright cure. At any given time, about 1,600 people in Britain are waiting for a matched donor for a transplant, hoping to survive long enough to get that chance.

Five-year-old Sorrel Mason was one such person. Three years ago Sorrel’s father noticed that she was looking pale, and she was eventually diagnosed with a rare strain of acute myeloid leukaemia. Her mother Samantha recalled the terrible fear and sense of helplessness that they felt at the time. She said:

“I remember the first time I saw her hooked up to all those machines. It broke my heart.”

After two doses of chemotherapy Sorrel was able to have a transplant, and received suitable stem cells from a mother’s umbilical cord from Tokyo—albeit an expensive imported cord; that is a point to which I shall return later. Thankfully, the procedure was a great success. In Samantha’s own words:

“Every day we waited for the daily blood counts. It was a miracle when eventually they came up okay.”

We are on relatively new ground here, because the first time a stem cell transplant took place using cells retrieved from a donated umbilical cord was in 1988. Since then, scientists have been discovering many advantages to the use of cord blood. You, Mr Speaker, will be relieved to know that I will refrain from reciting numerous tracts from the many academic papers on this subject. However, one especially noteworthy example of the great research work being carried out is the Cancer Research UK-funded trial being led by Dr Rachel Hough into the use of umbilical cord blood from unrelated donors for people who have cancer of the bone marrow or lymphatic system. Her team aims to investigate whether a transplant using cord blood cells can help cancer patients who cannot be matched to a bone marrow donor. This is an exciting and promising development that highlights the great potential for uncovering further benefits of cord blood.

The immediate benefit of a transplant from cord blood is that it achieves the same level of success for the patient at a significantly lesser degree of tissue matching. When I first raised this subject three years ago, we relied on speculation about the number of cord blood units needed for this country’s health needs. Now we know from evidence and with authority that a cord blood bank would have to maintain only 50,000 units to provide for the bulk of Britain’s unmet need for stem cells beyond the 770,000 registered adult donors. A great advantage of umbilical cords is the availability of the stem cells retrieved. They are collected, tissue-typed and frozen after the birth of the child, and then made available as soon as a patient requires them. That radically reduces the waiting time before a patient can access a transplant. Currently, the average time it takes for a patient to receive their transplant after the search for a match is started is some 160 days, during which time many patients become progressively weaker and the likely success of the transplant can thus be reduced.

Cord blood transplants save lives that other methods cannot, so it is no surprise that, globally, the proportion of transplants undertaken using cord blood is increasing every year. Great Ormond Street hospital, a leading transplant centre, will now use only cord blood where it is available. The pace of advance in this arena is excellent. Each year, the prognosis for patients treated is better than for those treated the year before, and that is because of the research taking place in the UK and around the world. Not only are blood cancers and similar disorders subject to increasingly effective treatments, but an active investigation is taking place into the use of cord blood in the treatment of sickle cell anaemia and HIV.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The hon. Gentleman will be aware that minority ethnic patients make up almost 20% of the unmet need for stem cell transplants, which is disproportionate to our 10% representation in the population. Does he agree that one of the important uses of this blood is in enabling ethnic minority patients, who find it more difficult to get a match, to have some hope?

[Mr Burrowes]

I am very grateful for that intervention. The hon. Lady and I share an interest in both sickle cell anaemia and the thalassaemia issue. The UK Thalassaemia Society, whose headquarters are in my constituency, has great interest in this area and, in particular, in the black and minority ethnic communities, who are not able to get matches through the bone marrow register and are acutely in need. That is particularly the case for mixed-race families, who struggle to find any match and are sometimes wholly reliant on a cord blood solution. That is why it is welcome that over the years the previous Government and this Government have increased the number of collection centres to make more of those units available.

However, more needs to be done because, sadly, where Britain once led, it is now falling behind the United States, France, Germany and Spain. All those countries now outstrip our cord blood collection, inhibiting our research capacity. There are 700,000 births each year in the UK and in almost every single instance the cord blood is discarded as medical waste. I am not proposing routine collection, but we must question the health and economic value of throwing all these potentially life-saving cords away. I welcome the fact that the Government are nudging people to agree voluntarily to donate their organs upon death, and I would encourage a similar nudge in encouraging mothers to consider donating umbilical cord blood.

Progress has been made, but more needs to be done. There are 1,600 people waiting for a stem cell transplant, but the unmet need in annual terms is only 440 transplants per year. A bank of just 50,000 umbilical cords would provide the bulk of that need. Sadly, simply increasing the size of the adult register is not an alternative to having cord blood. We already have access to more than 16 million donors on registers worldwide. The work of the Anthony Nolan Trust and others helps us to access that adult register, but we would need a UK adult register of a similar size to approach the effectiveness of a 50,000-unit cord blood bank.

[Mark Tami (Alyn and Deeside) (Lab)]

I thank the hon. Gentleman for his earlier comments. It is difficult to talk in financial terms about such issues, but with patients who do not get a transplant, there is a huge ongoing medical cost for their treatment, whereas a transplant could save that money, which could then be reinvested in the health service.

[Mr Burrowes]

We often talk about investing to save, but this is an area in which investment would save both money and lives. I shall go into that in more detail.

A report on transplantation by the UK Stem Cell Strategic Forum, ably chaired by Professor Charles Craddock, was published in December 2010 by NHS Blood and Transplant. The Minister discussed the report, which makes important recommendations, with the all-party group on the day of its publication. The report recommended, first, investing in expanding Britain’s cord blood bank capacity to 50,000 units. Those proposals have been properly costed and the costs have been balanced against effectiveness by NHS Blood and Transplant. For an investment of £50 million, spread over five years, Britain could have that 50,000-unit cord blood bank.

[Nadine Dorries (Mid Bedfordshire) (Con)]

I thank my hon. Friend for giving way. I want to congratulate him on the work that he has consistently put into this issue over the past three years, which is to be commended. Would he endorse the proposal that certain hospitals or regions could be piloted or allocated as regions to collect and donate the necessary 50,000 units? Rather than having routine testing across the country, it could be just in specific regions or units.

[Mr Burrowes]

I am grateful to my hon. Friend for making that point. There has been some progress on the areas that could retrieve unit cords, particularly from members of BME communities who lack those matches, but we also need to look further at matching that up with regional centres of excellence. I shall return to that point.

First, let me deal with the money issue, which we cannot ignore in this area of health. For an investment of £50 million over five years, we could get that 50,000-unit blood bank. Although it would be difficult to find £10 million a year for five years in these austere times, the financial benefits make sense. The blood bank would provide economies of scale that would reduce the cost to the NHS of every treatment and would radically reduce the need to import expensive stem cell units from abroad, which is, sadly, too common a practice today. The saving that would bring to the NHS has been calculated at £6 million a year in perpetuity. Within 10 years, the entire investment would have been repaid and the programme would save the NHS money for the foreseeable future—and then there are the 200 lives we can choose to save each year by taking that step. So, it would save £6 million and 200 lives a year, and those figures are with currently available treatments at success rates that are currently being achieved.

[Thomas Docherty (Dunfermline and West Fife) (Lab)]

I am very grateful to the hon. Gentleman for giving way. He has mentioned money several times. Is he aware of the work of the Round Table around Britain and Ireland, of which I am a member? It has consistently raised large sums for the Anthony Nolan Trust. Will he place on record his thanks to the Round Table movement for its support for the trust and this matter?

[Mr Burrowes]

I am grateful to that movement and other groups and charities that support this important work.

We need to ensure that we do well what we can do well by adopting the report’s second recommendation to establish regional centres of excellence in cord blood transplants. That would reduce the number of UK centres from 30 to 12, leading to a £12 million saving over 10 years. The report makes the point that that would, crucially, ensure that we had specialised, life-saving therapies in safe, publicly accountable environments. That is fully in line with the Government’s commissioning policy for specialised procedures and would provide great benefit.

The third, really exciting recommendation is about providing an opportunity to build on Britain’s unique strategic advantages, encouraging world-class research and private and voluntary sector growth that will provide new jobs and save further lives. The proposal to create a national trial programme in stem cell transplantation would take advantage of world-class centres of scientific research and the easy and sustained access to patients that the NHS provides. The proposal offers the potential for inward investment, private sector job creation and third sector involvement, as is well demonstrated by the success of the Centre for Clinical Haematology at the Queen Elizabeth hospital in Birmingham. To quote Professor Craddock:

“The unique international trials network will be highly attractive to pharmaceutical and biotechnology companies who wish to rapidly evaluate new drug therapies and can be anticipated to make a major contribution to the growth of private sector jobs in this sector.”

The Government, as we know, are encouraging growth. Where better than in the field of cord blood stem cell transplantation? The Minister has been kind enough to keep me informed of the progress that her Department is making in the development of a response to the proposals in the report. I hope the time is nearing when she will be able to make a statement on her plans in this area. I trust that in the complexities and scientific details of that report, her Department will be clear about the central message that 200 lives and £6 million can be saved each year.

In conclusion, I draw upon the story of Sorrel Mason. Prior to her life-saving procedure, her parents had never heard of the importance of cord blood donation and its benefits for stem cell transplant patients. No one could put it better than they did when they said:

“It’s quite hard in this country to donate your umbilical cord. Hopefully as time goes by there’ll be more places that offer this lifesaving opportunity.”

In a Parliament that will be characterised by the difficult decisions that it makes, this is one decision that we cannot afford not to take, and yes, I will say it again: it is vital to do so.