Steroids are the first line therapy for acute GVHD patients and are standard treatment for grade II-IV acute GVHD. Adverse effects of glucocorticoids include hypertension hyperglycemia and psychosis, immunosuppression, infections, myopathy, osteoporosis and avascular necrosis of bone, cataracts and fat re-distribution etc. If acute GVHD is not improved after 5-7 days treatment with steroids then it is considered as steroid-refractory. Various agents that are being investigated from last two decades as second line therapy include low-dose MTX, MMF, extracorporeal photopheresis, IL-2R targeting, antibody therapy against CD3, CD7, CD25, CD52, CD147, IL-2R, IL-1, and TNF-α (i.e., basiliximab, daclizumab, denileukin, diftitox and alemtuzumab), horse ATG, etanercept, infliximab, and sirolimus and recently infusions of mesenchymal stem cells.