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Cord blood stem cells help meet minority marrow needs
March 01, 2010
This was an unbalanced story touting "a medical breakthrough that's saving lives." Two rosy anecdotes are the only evidence we get. The online headline also emphasizes a "minority" angle that is barely touched on in the story.
Our Review Summary
A scan of the comments by readers shows how such journalism can inspire perhaps false hope. In addition, the lack of evidence evaluation and balance in this story prompted several readers, who claim to work with these patients, to describe a bleaker reality and caution against such false hope. One reader, BMTnurse, a self-described transplant nurse, note that patients he/she has seen "tend to do rather poorly" in comparison to sibling bone marrow transplant recipients, and that the procedure is a "last-resort treatment" and "certainly not a miracle." That nurse's personal assessment of the survival rate among procedures he/she has seen is "maybe 20 percent tops." Does that even feel like the same procedure described in this story?
It's a sad commentary when the commenters inject more balance and raise more important questions than the journalists.
Why This Matters:
Cord blood stem cell transplant is a valuable and evolving treatment option for certain cancers and other diseases. But the story should've included specifics on the limitations of the procedure, and a complete picture of benefits and harms. For patients struggling with leukemia treatment right now, or their families, the article might give them the expectation that this procedure is a new miracle cure. It isn't.
Click on Criteria for definitions.
This topic was unclear. The story implies that the chain of events from cord blood donation, national registration, and transplantation is currently available. We would like to have seen a clearer, more direct discussion on its current availability, and the statistics were vague. "Cord blood transplants among unrelated donors have risen from 1 percent in 2001 to 24 percent last year." 24 percent of what? Of all stem cell transplants? How many of those recipients were children?
The important distinction between use of this procedure in children and in adults should have been discussed.
The costs of donation are discussed, but not transplantation -- the treatment discussed. It's not cheap, and it may not be completely covered by insurance.
The article does not appear to engage in disease-mongering.
This article comes off like a commercial advertisement for this therapy. No evidence is presented to support its claims, only selective anecdotes to demonstrate the benefits and risks, both for the procedure itself and for the relative comparison to adult bone marrow transplants. In the video piece, we're told that this is a "Medical breakthrough that's saving lives," but the only evidence provided is two patient stories, and a vague comment that the risks are the same as for bone marrow transplant. If the procedure has an empirical 100% success rate -- it's 2 for 2 in these anecdotes -- why not choose this over bone marrow transplant?
Based on the vague statement that cord blood transplants have risen to 24% [of what?], apparently the vast majority of cases still don't use cord blood. If it's so good, why? The procedure has been around. The story doesn't explain the reason.
The answer may be in another point about which the story is unclear: when in the course of treatment is this procedure appropriate? Is it a first line of defense? Mr. Mumford's story does explain that he tried, and failed, to get a bone marrow donor first. But the word "traditionally" in the following sentence implies that this procedure might replace bone marrow transplants: "Traditionally, patients with leukemia, lymphoma and myeloma have first tried to find an adult bone marrow donor either from a close relative or from a national bone marrow registry." However, as described in a recent review of the evidence, cord blood transplant is recommended for patients who cannot have a bone marrow donor. The story makes it sound better than bone marrow transplant, without providing any evidence.
See the larger discussion of the evidence evaluation.
The story mentions that the procedure has the same risks as adult bone marrow transplants, and that the procedure requires months of recovery. These risks aren't quantified -- they're just "well worth it," according to these two success stories. The article makes the procedure seem like a no-brainer. There are many other risks with these transplants, none of which are mentioned. Detail about any of the risks, including the rates of death due to the procedure, are missing. As that reader who claims to be a transplant nurse, BMTnurse, commented on the CNN web page: "Those whose transplants fail tend to die miserably."
Since the story states that more than 200 hospitals nationally accept cord blood donations, a reader can see that this is not a new procedure.
See the larger discussion of the evidence evaluation.
None of the potential benefits were quantified -- survival, quality of life, etc. Advantages over bone marrow transplant are enumerated, but the only patient outcome discussed is 100% cure for these two patients and, in a vague afterword, the potential for rejection. The lack of more detail about outcomes fans the flames of this "medical breakthrough that's saving lives." The truth is that this procedure doesn't cure everyone who gets it. One 2004 study found that adults with leukemia who received cord blood transplants didn't live any longer than those who received bone marrow.
The story does not appear to rely solely on a news release.
The online story quotes only one physician. Another independent expert might have raised some of the questions that we have raised throughout this review.
The story mentions ways in which cord blood donation is superior to or no worse than adult bone marrow transplant. Overall it implies that cord blood donation is jumping the queue to become the preferred choice of the two, as a "medical breakthrough that's saving lives.". But the fact that bone marrow is still considered first for adults, and the reasons why, are not discussed.
Total Score: 3 of 10 Satisfactory
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