Autologous Hematopoietic Stem Cell Transplantation in Systemic Sclerosis: Current Evidence and Future Directions

Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease marked by progressive fibrosis and multi-organ involvement, most notably in the lungs. Among patients with rapidly progressive diffuse cutaneous SSc and interstitial lung disease (ILD), autologous hematopoietic stem cell transplantation (AHSCT) has emerged as one of the most effective disease-modifying strategies to confer a survival benefit in randomized trials. This review summarizes the evidence from randomized controlled trials, mechanistic studies, and real-world data to evaluate the role of AHSCT in SSc, with a focus on ILD and skin outcomes, immune reconstitution, and long-term efficacy. Current controversies, including conditioning intensity, CD34+ selection, and future directions in the field, are discussed.