How do you manage steroid-refractory acute GVHD following allogeneic transplant?

The short answer is to enroll the patient in a well-designed clinical trial, if available.

If not, I would start with ruxolitinib based on the REACH2 trial (Zeiser et al., PMID 32320566) which was multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitinib (10 mg twice daily) with the investigator's choice of therapy from a list of nine commonly used options (control) in patients who had corticosteroid-refractory acute GVHD after allogeneic stem-cell ...