DISEASE CHARACTERISTICS:

• Diagnosis of severe systemic sclerosis (SSc) as defined by the American College of Rheumatology

• At high-risk for a fatal outcome based on the following prognostic factors from any of the following groups as defined below:

  • Group 1: Patients must meet both of the first two criteria AND ≥ 1 of the last three criteria, including the following:

    • Diffuse cutaneous scleroderma with skin score of ≥ 16 (modified Rodnan Skin Score [mRSS])
    • Duration of systemic sclerosis ≤ 5 years from the onset of first non-Raynaud's symptom
    • Presence of interstitial lung disease (FVC or corrected DLCO < 70% of predicted) and evidence of alveolitis (abnormal bronchoalveolar lavage [BAL] or high resolution chest CT scan) despite treatment with pulse cyclophosphamide (≥ 500 mg/m^2 per month) for ≥ 3 months

    • Left heart failure with LVEF < 50%, pericardial effusion (mild-moderate), or second- or third-degree atrioventricular block

      • Myocardial disease not secondary to SSc must be excluded by a cardiologist
    • History of SSc-related renal disease that is not active at the time of study screening, including history of scleroderma hypertensive renal crisis

  • Group 2: Patients must have progressive pulmonary disease as the primary indication for transplant, as defined by a decrease in the FVC or DLCO by ≥ 15% within the past 12 months AND evidence of alveolitis (abnormal chest CT scan or BAL)

    • May have either less skin involvement than group 1 (mRSS < 16) and FVC or corrected DLCO < 70% of predicted OR both FVC and corrected DLCO ≥ 70% of predicted provided there is diffuse cutaneous disease (mRSS ≥ 16) at study screening

  • Group 3: Patients must have progressive active SSc after prior autologous stem cell transplant (SCT) based on the presence of progressive pulmonary disease

    • Progressive pulmonary disease is defined by a decrease in the FVC or DLCO by ≥ 15% since prior autologous SCT AND evidence of alveolitis (abnormal chest CT scan or BAL)
    • Patients who have undergone prior autologous SCT on FHCRC-1948 (SCOT clinical trial) must have failed the transplant based on the defined study endpoints and be approved by the study Principal Investigator

• Failed one of the following oral or IV cyclophosphamide regimens (unless corrected DLCO < 45% of predicted):

  • IV cyclophosphamide administered for > 3 months or a total cumulative IV dose of 3g/m^2
  • Oral cyclophosphamide administered for > 4 months, regardless of dose
  • Combination of oral and IV cyclophosphamide administered for > 6 months, independent of dose

• Ineligible for FHCRC-1948 (SCOT clinical trial)

  • Patients who are eligible for FHCRC-1948 (SCOT clinical trial) who refuse participation on the SCOT clinical trial secondary to concerns of loss of fertility and other potential toxicities of high-dose immunosuppressive therapy (HDIT) are eligible for this clinical trial
• No myelodysplastic syndromes

• HLA genotypically identical sibling or unrelated donor available

  • No identical twin donor
  • Unrelated donors are required to be matched by standard molecular methods at the intermediate resolution level at HLA-A, -B, -C and -DRB1 and the allele level at DQB1

PATIENT CHARACTERISTICS:

• ANC > 2,000/mm^3 (unless marrow cellularity > 40% with trilineage hematopoiesis by bone marrow biopsy)
• Platelet count > 120,000/mm^3 (unless marrow cellularity > 40% with trilineage hematopoiesis by bone marrow biopsy)

• No organ dysfunction as defined by any of the following criteria:

  • Creatinine clearance < 60 mL/min
  • Uncontrolled clinically significant arrhythmia
  • Clinical evidence of significant congestive heart failure (NYHA class III or IV congestive heart failure)
  • LVEF < 40% by echocardiogram
  • Severe pulmonary dysfunction, defined as hemoglobin corrected DLC0 < 30%, FVC < 45% of predicted, or O_2 saturation < 92% at rest without supplemental oxygen

  • Significant uncontrolled pulmonary hypertension, defined by any of the following:

    • Pulmonary artery peak systolic pressure > 55 mm Hg by echocardiogram
    • Pulmonary artery peak systolic pressure 45-55 mm Hg by echocardiogram and mean pulmonary artery pressure > 25 mm Hg at rest (or > 30 mm Hg with exercise) by right heart catheterization
    • WHO/NYHA class III or IV pulmonary hypertension
  • Active hepatitis or evidence of cirrhosis or periportal fibrosis by liver biopsy
  • Total bilirubin > 2 times upper limit of normal (ULN) and/or SGOT and SGPT > 4 times ULN
• No evidence of ongoing active infection
• No poorly controlled hypertension
• Life expectancy not severely limited by illness other than autoimmune disease
• No poorly controlled bleeding from gastric antral vascular ectasia (GAVE) or other gastrointestinal sites
• No untreated psychiatric illness
• No drug or alcohol abuse
• No demonstrated lack of compliance with prior medical care
• No HIV seropositivity
• No malignancies except squamous cell or basal cell carcinoma of the skin
• Not pregnant
• Fertile patients must use effective contraception during and for 12 months following transplant

PRIOR CONCURRENT THERAPY:

• Not specified