ArticleVirology journal2026
Longitudinal TCR repertoire profiling predicts refractory cytomegalovirus reactivation after haploidentical hematopoietic stem cell transplantation.
Article in Virology journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCytomegalovirus (CMV) reactivation is a major cause of morbidity and mortality after haploidentical hematopoietic stem cell transplantation (Haplo-HSCT). While T cells are crucial for controlling CMV, the dynamic characteristics of the T-cell receptor (TCR) repertoire and their predictive value for refractory CMV reactivation remain poorly characterized. This study aimed to longitudinally monitor the TCR repertoire in Haplo-HSCT patients to identify features associated with CMV reactivation and to explore predictive biomarkers for refractory and recurrent CMV disease.
methodsWe enrolled 164 Haplo-HSCT patients, of which a subset of 28 was prospectively monitored for TCR repertoire dynamics via multiplex PCR and high-throughput sequencing. Patients were stratified into control (no reactivation, n = 10), acute phase (first reactivation, n = 18), and resolution phase (after clearance, n = 18) groups. CMV-specific TCRs were identified by database matching.
resultsThe incidence of CMV reactivation was 48.17% (79/164). CMV reactivation induced significant perturbations in TCR repertoire architecture, characterized by increased CDR3 clonality, reduced clonotype distribution evenness, and a decreased number of unique Clonotypes (all P < 0.05) compared to controls, indicating a state of oligoclonal expansion. This skewed architecture persisted even after viral clearance, suggesting delayed CMV-specific immune reconstitution. Consistent with this, patients with CMV reactivation had significantly lower CD4
conclusionThe abundance of CMV-specific TCRs is a key predictor of refractory CMV reactivation post-Haplo-HSCT. Longitudinal TCR profiling offers a promising strategy for risk stratification, potentially guiding more personalized preemptive therapies.
trial registrationNot applicable.
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