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H H S Department of Health and Human Services
Health Resources and Services Administration
Blood Cell Transplant

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Summary Consensus Recommendations

Summary of Advisory Council on Blood Stem Cell Transplantation (ACBSCT) Consensus Recommendations to the Secretary of Heath and Human Services (HHS)

April 28-29, 2008

  • Recommendation 1
    ACBSCT recommends to the Secretary that the Food and Drug Administration (FDA) finalize its Draft Guidance for Industry on Minimally Manipulated, Unrelated Allogeneic Placental/Umbilical Cord Blood Intended for Hematopoietic Reconstitution in Patients with Hematological Malignancies. Full Recommendation
  • Recommendation 2
    ACBSCT recommends that the Secretary of HHS increase funding of the Center for International Blood and Marrow Transplant Research’s (CIBMTR) U24 cooperative agreement with National Cancer Institute (NCI) (U24 CA 76518). Full Recommendation

December 15-16, 2008

  • Recommendation 3
    ACBSCT recommends that the Secretary direct the Centers for Medicare & Medicaid Services (CMS), as a high priority, to develop an appropriate strategy for the National Coverage Determination of allogeneic stem cell transplantation as therapy for the Myelodysplastic Syndromes based on the recent evidence-based review of the literature. Full Recommendation
  • Recommendation 4
    ACBSCT recommends to the Secretary that the Health Resources and Services Administration’s (HRSA) C.W. Bill Young Cell Transplantation Program (Program) implement the following policies for protecting the privacy and confidentiality of cord blood donors donating umbilical cord blood units to the Program. Public Law 109-129 (42 U.S.C. 274k; Section 379 of the Public Health Service Act) defines a qualified cord blood bank participating in the National Cord Blood Inventory (NCBI) as having the following confidentiality requirements: 1) a system to confidentially maintain a linkage between a cord blood unit and a maternal donor; and 2) a system of strict confidentiality to protect the identity and privacy of patients and donors in accordance with existing Federal and State law. Full Recommendation

May 12, 2009

  • Recommendation 5
    ACBSCT recommends the Secretary recognize both the American Association of Blood Banks (AABB) and the Foundation for the Accreditation of Cellular Therapy (FACT) as Accreditation Organizations for the National Cord Blood Inventory (NCBI).  Both organizations are expected to adhere to the Health Resources and Services Administration’s (HRSA) Specifications for Accreditation Organizations, and their continued recognition is based on ongoing adherence to HRSA Specifications.  ACBSCT will review, three years from the time of the recognition decision by the Secretary, HRSA’s experience with the Accreditation Organizations with regard to meeting the HRSA Specifications. Full Recommendation

September 21, 2009

  • Recommendation 6
    ACBSCT recommends to the Secretary that the following informed consent principles and standards be implemented for public cord blood banking. Full Recommendation

May 5, 2010

  • Recommendation 7
    ACBSCT recommends to the Secretary that an expert panel be convened to review and determine indications for stem cell transplantation. Full Recommendation
  • Recommendation 8
    ACBSCT recommends that the Secretary mandate that Medicare and Medicaid cover patient participation in clinical trials involving hematopoietic transplantation. Full Recommendation
  • Recommendation 9
    ACBSCT recommends to the Secretary that cord blood collections be increased and improved. Full Recommendation

November 15, 2010

  • Recommendation 10
    ACBSCT recommends that the Secretary recognize hematopoietic transplantation for generally accepted indications as a covered benefit for all Federal programs for which the Secretary has appropriate responsibility and oversight. Full Recommendation
  • Recommendation 11
    ACBSCT recommends to the Secretary that Medicare reimburse for the acquisition of blood, marrow and cord blood products for hematopoietic transplantation on a cost basis similar to how reimbursement is made for graft acquisition in solid organ transplantation.  Full Recommendation
  • Recommendation 12
    For cord blood units incapable of bearing a full label, ACBSCT recommends the Secretary clarify that the expiration date can be placed on an attached label provided with the unit at time of release to a transplant center. Full Recommendation
  • Recommendation 13
    ACBSCT recommends the Secretary work with FDA to review requirements for licensure in light of concerns over the potential for licensure requirements to result in increased cost and decreased availability of public cord blood units with the goal that FDA urgently meet with the cohort of applicant cord blood banks and representatives of transplant centers to share and resolve specific concerns regarding licensure. Full Recommendation
  • Recommendation 14
    ACBSCT recommends to the Secretary that models for remote collection of cord blood units be allowed with only limited, scientifically justified safety precautions. The Council also recommends that the Secretary allow for cord blood unit collection from routine deliveries without temperature or humidity monitoring of delivery rooms in hospitals approved by the appropriate bodies for hospital accreditation. Full Recommendation

May 11, 2011

  • Recommendation 15
    Consistent with Congressional mandates and strategic efforts to expand collection site participation, ACBSCT recommends that the Secretary recognize public cord blood bank oversight of the collection process as sufficient means to ensure safe manufacturing practices, and oppose the requirement for hospitals to register with the FDA as the establishment responsible for recovery. Full Recommendation
  • Recommendation 16
    Based on data from nearly two decades of practice controlled by public cord blood banks to ensure safe collection processes and protect product integrity, ACBSCT recommends that the Secretary support the collection of cord blood from uncomplicated deliveries in accredited hospitals without environmental monitoring of delivery rooms. Full Recommendation

November 8, 2011

  • Recommendation 17
    The Council recommends to the Secretary that the U.S. Food and Drug Administration(FDA) recognize and accept laboratory-developed testing performed in Clinical Laboratory Improvement Act(CLIA)-certified, high complexity histocompatibility laboratories. Full Recommendation
  • Recommendation 18
    The Council recommends that FDA broaden the investigational new drug(IND) and biologics license application(BLA) clinical indications for unrelated donor cord blood transplantation to include use for hematopoietic and/or immune reconstitution or enzyme replacement in any situation where hematopoietic stem cell transplantation(HSCT) is the appropriate approach to treatment.  Full Recommendation
  • Recommendation 19
    The Council recommends that all cord blood products have the same IND and BLA clinical indications; this is scientifically and medically sound. Full Recommendation
  • Recommendation 20
    The Council recommends implementation of a transition plan, initially stated as on or before October 20, 2011, to allow time for the FDA to review recommendations 17 and 18 above and to allow for implementation of any changes by transplant centers who will need to put these changes through their institutional review boards. Full Recommendation
  • Recommendation 21
    The Council recommends that CBUs collected through distribution of kits sent to motivated maternal donors or obstetrical units collected by an obstetric provider, which meet all National Cord Blood Inventory(NCBI)/FDA qualifications be eligible for listing on the NCBI and for FDA licensure. Full Recommendation

May 9, 2012

  • Recommendation 22
    The Advisory Council recommends that the Secretary take and support all reasonable efforts to insure that compensation for marrow, peripheral blood stem cells and similar products continues to be prohibited. Full Recommendation

May 16, 2013 

  • Recommendation 23
    The Council recommends that the Secretary consider appropriate mechanisms to assure that the revised National Heart, Lung, and Blood Institute publication "Management and Therapy of Sickle Cell Disease" includes expert opinion about the curative option of hematopoietic cell transpolantation for this disorder.
  • Recommendation 24
    The Council recommends that HRSA undertake educational/outreach efforts to the sickle cell disease (SCD) patient and provider community to educate them about the progressive nature of SCD, increasing morbidity and mortality in early adulthood (ages 16-35 years), and the role of HSCT and its complications.
Full Consensus Recommendations
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