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Over the last 20 years stem cell transplant (SCT) has shown promising results in a variety of autoimmune rheumatologic disorders.  Of these conditions, systemic sclerosis (SSc) has garnered the most attention given the limited alternative options for advanced disease.  Several early studies and now several randomized controlled trials have demonstrated improved skin, lung, and vascular outcomes.  However complications associated with the immunoablating steps in the transplant process have led to cardiotoxicity, infections, and death in some transplant recipients.  Growing efforts are being made to examine how to optimize the transplant process to improve safety but retain efficacy.