Long-Term Use of Ruxolitinib in an AML Patient withPosttransplant Steroid Refractory GVHD

Ruxolitinib has become a new therapeutic option for steroid refractory graft-versus-host disease (srGVHD), with a substantialremission rate. Its anti-inflammatory properties by blocking interleukin pathways have made it a novel therapeutic approach toinflammatory disease processes, such as GVHD. The long-term use of ruxolitinib has not been explicitly studied outside thecontext in the treatment of multiple myeloma. With current clinical trials underway for the use of ruxolitinib in srGVHD, thereare still no current guidelines or protocols for long-term clinical use. Of the available literature showing ruxolitinib utilizationfor srGVHD, most cases lead to resolution and eventual discontinuation. We present a case of a 32-year-old male on ruxolitinibwith GVHD status postmatched unrelated donor stem cell transplant (MUD SCT) for acute myeloid leukemia (AML) withFLT3 mutation currently on ruxolitinib for 5 years who is not able to tolerate reduction in dosage due toflare-ups. We discussthe clinical implications and nuance of therapy with ruxolitinib with unknown long-term effects and weigh the risks and benefits.