How do you approach steroid-refractory GVHD in patients who either cannot receive ruxolitinib or do not respond to ruxolitinib?   

Both acute and/or chronic GVHD could be steroid-refractory. In patients with acute steroid-refractory GVHD, I would target therapy based on organ involvement. If skin is involved and the patient cannot take or get ruxolitinib, I would use ATG first, in particular if severe disease, but there is a n...