Ben Moussa ML, Chelbi Y, Kharrat R, Berred R, Ben Lakhal R, Hamdoun M, Bahri O. Cytomegalovirus reactivation risk after autologous hematopoietic stem cell transplantation: Results of a Tunisian study. World J Virol 2025; 14(4): 115626 [DOI: 10.5501/wjv.v14.i4.115626]
Corresponding Author of This Article
Mouna Louiza Ben Moussa, MD, Laboratory of Microbiology and Biochemistry, Aziza Othmana Hospital, Rue de la Kasbah, Tunis 1008, Tunisia. mounabenmoussa46@yahoo.fr
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Virology
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 25, 2025 (publication date) through Dec 25, 2025
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World Journal of Virology
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2220-3249
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Ben Moussa ML, Chelbi Y, Kharrat R, Berred R, Ben Lakhal R, Hamdoun M, Bahri O. Cytomegalovirus reactivation risk after autologous hematopoietic stem cell transplantation: Results of a Tunisian study. World J Virol 2025; 14(4): 115626 [DOI: 10.5501/wjv.v14.i4.115626]
World J Virol. Dec 25, 2025; 14(4): 115626 Published online Dec 25, 2025. doi: 10.5501/wjv.v14.i4.115626
Cytomegalovirus reactivation risk after autologous hematopoietic stem cell transplantation: Results of a Tunisian study
Mouna Louiza Ben Moussa, Yasmine Chelbi, Rachid Kharrat, Rabeb Berred, Raihane Ben Lakhal, Manel Hamdoun, Olfa Bahri
Mouna Louiza Ben Moussa, Yasmine Chelbi, Manel Hamdoun, Olfa Bahri, Laboratory of Microbiology and Biochemistry, Aziza Othmana Hospital, Tunis 1008, Tunisia
Mouna Louiza Ben Moussa, Yasmine Chelbi, Rachid Kharrat, Rabeb Berred, Raihane Ben Lakhal, Manel Hamdoun, Olfa Bahri, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis 1007, Tunisia
Rachid Kharrat, Rabeb Berred, Raihane Ben Lakhal, Unit of Clinic Hematology, Aziza Othmana Hospital, Tunis 1008, Tunisia
Author contributions: Ben Moussa ML was responsible for conceptualization, data curation, data collection, formal analysis, and writing original draft; Chelbi Y was responsible for data collection; Kharrat R, Berred R, Ben Lakhal R, and Hamdoun M were responsible for clinical data acquisition and patient management; Bahri O was responsible for supervision, writing review and editing; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The study protocol was reviewed and approved by the local Ethics Committee of Aziza Othmana Hospital.
Informed consent statement: This study was retrospective in nature and based solely on the review of existing medical records. No direct patient contact or intervention was involved. All data were anonymized before analysis. Therefore, individual informed consent was not required, in accordance with the national and institutional ethical guidelines.
Conflict-of-interest statement: The authors declare no conflict of interest related to this study.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: The datasets generated and analyzed during the present study are not publicly available due to institutional confidentiality policies and the retrospective nature of the data. However, anonymized data may be made available from the corresponding author upon reasonable request and with approval from the local Ethics Committee of Aziza Othmana Hospital.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mouna Louiza Ben Moussa, MD, Laboratory of Microbiology and Biochemistry, Aziza Othmana Hospital, Rue de la Kasbah, Tunis 1008, Tunisia. mounabenmoussa46@yahoo.fr
Received: October 21, 2025 Revised: November 14, 2025 Accepted: December 8, 2025 Published online: December 25, 2025 Processing time: 65 Days and 11.6 Hours
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.
Core Tip: This retrospective cohort study analyzed cytomegalovirus (CMV) reactivation after autologous hematopoietic stem cell transplantation in 277 patients. CMV reactivation occurred in 6.1% of cases, often spontaneously resolving but occasionally leading to severe disease and death in patients with high viral loads. Initial and peak viral loads were significantly associated with treatment need, supporting viral quantification as a key decision tool. These findings emphasize the importance of systematic post-transplant CMV monitoring and early preemptive therapy to prevent progression to clinically significant CMV disease.
