Plasma torque teno virus (TTV) DNA load directly correlates with the degree of T-cell immune reconstitution early after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Here, the kinetics of oral TTV DNA shedding was examined to assess whether quantitation of TTV DNA load in saliva may either replace or complement that in plasma for predicting lymphocyte (ALC) reconstitution after engraftment. This prospective observational study enrolled 38 nonconsecutive allo-HSCT recipients. Saliva and plasma specimens were collected at baseline (pretransplant) and at around days +30, +50, and +90 after allo-HSCT. TTV DNA was quantitated in both specimen types by real-time PCR. ALCs were measured by cytometry. A total of 104 paired saliva and plasma specimens were available for TTV PCR analyses. TTV DNA was detected more frequently in saliva than in plasma specimens at all time points (overall, 94.2% vs 86.5%). Increasing levels of TTV DNA were seen in both specimen types from day +30 to day +90 after transplantation. Overall, TTV DNA loads were significantly higher in saliva than in plasma specimens (P = .0002) and correlated significantly (P ≤ .0001). A direct correlation between TTV DNA loads in saliva and plasma and ALCs was observed after engraftment (P = .034 and P = .002, respectively). Future studies should be aimed at determining whether monitoring of oral TTV DNA shedding may be of any utility for inference of immune reconstitution after allo-HSCT.
It has been reported that low‐plasma cytomegalovirus (CMV) DNA loads are associated with an increased risk of overall mortality in allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Utilizing a conservative strategy for initiation of preemptive antiviral therapy (>1500 IU/mL), we characterized the virological features of spontaneously‐resolving episodes of CMV DNAemia and assessed their impact on mortality through the first year after transplantation. We reviewed the CMV DNA polymerase chain reaction results and clinical charts of 230 consecutive adult patients who underwent T‐cell replete allo‐HSCT at our center. A total of 280 episodes of CMV DNAemia were registered in 164 patients, of which 144 episodes cleared spontaneously. Clearance of CMV DNAemia was significantly delayed in initial and recurrent self‐resolving episodes featuring CMV DNA peak loads > 250 IU/mL compared with those displaying lower values. All‐cause mortality in patients with self‐resolving episodes of CMV DNAemia was comparable (P = 0.7) to that in patients with no CMV DNAemia and was not related to the CMV DNA peak load (≥250 IU/mL vs <250 IU/mL) (P = 0.6). In summary, in our setting, the magnitude of the CMV DNA peak load reached during self‐resolving episodes of CMV DNAemia correlated directly with duration of episodes, but had no apparent impact on all‐cause mortality taking patients with no documented CMV DNAemia as a reference.
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