# Torque Teno Virus (TTV) Plasma Load and Immune Reconstitution Post-Transplantation in Patients with Lymphoproliferative Disorders: A Systematic Review

## TL;DR

This review examines how Torque Teno Virus (TTV) levels in the blood relate to immune recovery after stem cell transplants in patients with lymphoproliferative disorders.

## Contribution

The study systematically reviews TTV's potential as a biomarker for immune reconstitution in hematopoietic stem cell transplantation.

## Key findings

- TTV levels peaked between 90 to 120 days post-transplantation across studies.
- Results on TTV's association with immune parameters were inconsistent.
- Clinical and methodological differences among studies may explain conflicting findings.

## Abstract

Torque Teno Virus (TTV), a common and genetically diverse component of the human virome, is not linked to any known disease but reflects immune status. Its plasma viral load has shown clinical relevance in solid organ transplant recipients, correlating it with immunosuppression when present at high levels. However, the clinical significance of TTV viral load in hematopoietic stem cell transplantation (HSCT) recipients is less understood. This systematic review aims to evaluate whether plasma TTV DNA load directly correlates with the degree of T-cell immune reconstitution after HSCT, supporting its potential role as a biomarker for immune competence. The study protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD420251116208) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-one studies were included. The results showed concordant data about TTV kinetics with peak levels reaching approximately between +90 to +120 days after transplantation. Contradictory results have instead been found for the association of TTV load with immune parameters (lymphocyte counts, viral opportunistic infection, and development of acute graft versus host diseases). Even if a low-risk bias assessment was classified in most studies (67%), it was possible to identify important clinical and methodological differences between them, which might account for the different findings observed. Therefore, future larger studies with standardized protocols are needed to assess whether TTV viral load can serve as a reliable tool for guiding clinical decisions in the context of HSCT.