Acute graft versus host disease (aGvHD) remains one of the most serious complications, occurring in about 30-70%, of allogeneic hematopoietic stem cell transplantation (HSCT) recipients. While about 40-60% of these recipients will respond to steroids as first line, there is no consensus on second line agents. The management of steroid-refractory (SR) and steroid dependent (SD) GVHD after HSCT continues to be challenging. In the absence of clinical trials, treatment in most cases is based on individual physician or center experience. Herein, we present our institutional experience with the use of bortezomib, a first-generation reversible proteasome inhibitor, in SD aGvHD.