Cytomegalovirus reactivation risk after autologous hematopoietic stem cell transplantation: Results of a Tunisian study

Abstract

BACKGROUND Cytomegalovirus (CMV) reactivation is a potentially severe complication in immunocompromised patients, yet its incidence and impact in recipients of autologous hematopoietic stem cell transplantation (AHSCT) remain insufficiently documented. AIM To assess the frequency, timing, and outcomes of CMV reactivation in patients undergoing AHSCT at Aziza Othmana Hospital. METHODS We conducted a retrospective descriptive study of all patients who underwent AHSCT between January 2022 and December 2024 and had at least one post-transplant plasma viral load (VL) assessment. CMV VL was quantified by real-time polymerase chain reaction using TaqMan probes (GeneProof®) with a sensitivity threshold of 150 IU/mL. RESULTS Among 277 AHSCT recipients, 17 (6.1%) experienced CMV reactivation. Their median age was 43 years, with a sex ratio of 0.46 (male/female). Underlying diseases included large B-cell lymphoma (n = 5), multiple myeloma (n = 3), and Hodgkin’s lymphoma (n = 4). The median time to reactivation was 26 days post-transplant (11 days after neutrophil recovery). Median peak VL was 1325 IU/mL (range: 150-641000 IU/mL). Six patients required antiviral therapy (median peak VL: 30150 IU/mL), while 11 had spontaneous resolution (median peak VL: 1320 IU/mL). Two patients died in the context of CMV reactivation. CONCLUSION CMV reactivation occurs in a noteworthy proportion of AHSCT recipients and may lead to severe outcomes. Routine VL monitoring in the early post-transplant period is crucial, and preemptive therapy should be initiated once clinically relevant VL thresholds are reached to prevent progression to CMV disease and associated mortality.