Table 4. AHSCT procedures according to EBMT and international consensus.

Mobilization and Leukapheresis	PBSCs may be mobilized using either cyclophosphamide 2g/m2 infused in one session or 4g/m2 divided equally over 2 consecutive days followed by G-CSF 5–10 μg/kg/day and leukapheresis according to institutional protocols. A minimum of 3.0 × 106/kg CD34+ at harvest and freeze resulting in minimum 2.0 × 106/kg viable CD34+ cells is required for transplant.
Conditioning and peripheral stem cell infusion	Conditioning should not be initiated until at least 3–4 weeks of mobilization cyclophosphamide dose to minimize accumulated acute cyclophosphamide myocardial injury.
	Prior to conditioning a central venous catheter will be placed.
	The current published conditioning regimen consists of cyclophosphamide 50 mg/kg/day intravenously for 4 consecutive days (total 200 mg/kg) and rbATG (thymoglobulin) at total doses of 6.5–7.5 mg/kg, delivered according to institutional protocols.
	Given the potential of ATG-induced fever to destabilize patients, intravenous methylprednisolone >3–10 mg/kg will be given to improve tolerability of the rbATG and decrease fever. ATG fever is also minimized by limiting the first dose of ATG to not more than 0.5 mg/kg.
	The interval between the last dose of cyclophosphamide and infusion of the graft should be at least 48 h.
	On day 0 stem cells are thawed and infused according to local standard operating procedures.
	The minimum number of CD34+ cells reinfused should be 2 × 106/kg, whether the graft is unselected or CD34+ selected.
Supportive care	Supportive care measures, including prophylactic or therapeutic antibiotics, anti-viral, anti-pneumocystis and anti-fungal agents, will be taken according to local standard operating procedures for such patients. Adherence to specific guidelines is recommended (according to EBMT standards).
	Transfusions will be given in accordance with local standard operating procedures for such patients. Based on current transplantation-experiences in scleroderma patients, particular attention should be paid to thrombocytopenia, bleeding tendency, hypo and hypertension, and respiratory insufficiency.
	For both mobilization and conditioning, cyclophosphamide should be given with appropriate hydration and mesna (to prevent hemorrhagic cystitis), but extreme care must be taken in fluid balance management as patients are sensitive to overload.

Abbreviations: AHSCT=autologous hematopoietic stem cell transplantation; EBMT=European Society for Blood and Marrow Transplantation; rbATG=rabbit antithymocyte globulin.