Inclusion Criteria

PROTOCOL ENTRY CRITERIA:

--Disease Characteristics--

- Diagnosis of 1 of the following based on American College of Rheumatology (ACR)
Criteria: Severe juvenile rheumatoid arthritis (systemic onset or polyarticular
course) Juvenile systemic lupus erythematosus Systemic sclerosis Dermatomyositis

- Refractory to standard or aggressive therapy OR unacceptable toxicity from standard
therapy

- Reasonable expectation of possible improvement as evidenced by a good potential for
rehabilitation therapy and adequate social factors

- No serious CNS damage that would preclude significant functional recovery

--Prior/Concurrent Therapy--

- Chemotherapy: At least 4 weeks since prior methotrexate or cyclophosphamide

- Endocrine therapy: At least 4 weeks since prior intra-arterial steroids Juvenile
rheumatoid arthritis patients should continue steroids without taper throughout
mobilization and harvest of stem cells If receiving corticosteroids, must be
continued without taper

Other:

- At least 4 weeks since prior anti-inflammatory agents such as non-steroidal
anti-inflammatory drugs (NSAIDs) or sulfasalazine

- At least 4 weeks since prior cyclosporine, tacrolimus, mycophenolate mofetil,
azathioprine, penicillamine, or etanercept

--Patient Characteristics--

- Life expectancy: At least 30 days

- Hematopoietic: Absolute neutrophil count at least 1,000/mm3 OR Platelet count at
least 100,000/mm3 No bone marrow aspirate or biopsy consistent with production defect
(depletion of neutrophil precursors or megakaryocytes) No myelodysplasia

- Hepatic: Bilirubin no greater than 2.5 mg/dL AST no greater than 300 U/L on two
sequential tests No severe liver dysfunction within past month No active hepatitis A,
B, or C

- Renal: No end-stage glomerulonephritis or renal disease Creatinine clearance at least
40 mL/min

- Cardiovascular: No uncontrolled malignant arrhythmia No New York Heart Association
class III or IV congestive heart failure Ejection fraction at least 50%

- Pulmonary: DLCO at least 45% (DLCO at least 70% for patients with pulmonary disease
caused by documented processes other than primary autoimmune disorder, such as
infectious pneumonia or aspiration pneumonia) No severe pulmonary hypertension (PAP
greater than 50) without potential for significant improvement

Other:

- No medical or psychosocial reasons that would make hematopoietic stem cell collection
intolerable

- No increased anesthetic risks

- No fever higher than 39 degrees C

- No positive serology for toxoplasmosis

- No active life threatening infection not responsive to therapy

- No other disease or organ dysfunction that would limit survival

- No known hypersensitivity to murine or equine proteins

- No known primary immunodeficiency disease HIV negative