Cytomegalovirus Infection After CD‐34 Selected Autologous Hematopoietic Stem Cell Transplantation for Systemic Sclerosis

ABSTRACT Background Autologous hematopoietic stem cell transplantation (AHSCT) is increasingly used to treat systemic sclerosis (SSc). Data on post‐AHSCT infections, including cytomegalovirus (CMV) in this population, are limited. This study aimed to assess risk factors, infection rates, and outcomes of post‐transplant CMV infection following CD34‐selected AHSCT for SSc. Methods We performed a single‐center retrospective study of all AHSCT recipients for SSc complicated by CMV infection. A standardized pre‐emptive CMV monitoring approach was employed throughout the study period (antiviral treatment threshold: plasma VL > 450 IU/mL). The primary outcome was the rate of CMV DNAemia or disease. Secondary outcomes included risk factors, management, and treatment outcomes. Results Among 42 AHSCT recipients, 19 (45%) were CMV‐seropositive pre‐transplant. CMV DNAemia occurred in 10/42 (24%) recipients post‐transplant, of which 8/10 (80%) were CMV‐seropositive. Median time to CMV DNAemia was 28 days (range: 21–35) post‐transplant, with a median peak VL of 665 IU/mL (IQR: 340–1104). There were no cases of CMV disease. CMV seropositivity pre‐transplant was a significant predictor of post‐transplant CMV DNAemia (relative risk: 4.84, 95% CI: 1.16–20.14; p = 0.026). Of 10 patients with CMV DNAemia, six (60%) received CMV‐targeted therapy while four (40%) resolved without treatment. Median duration of CMV targeted therapy was 35 days (IQR: 29–45). One patient (10%) experienced gastrointestinal intolerance necessitating antiviral discontinuation. No patient died or required hospitalization due to CMV infection. Conclusions CMV DNAemia following CD34‐selected AHSCT occurred primarily in CMV‐seropositive recipients. Though common, CMV DNAemia occurred early post‐transplant and was associated with minimal morbidity.