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The authors report a patient who developed severe graft versus host disease (GVHD) after undergoing a matched, unrelated bone marrow transplant. Her symptoms worsened despite treatment with cyclosporine, high doses of methylprednisolone, and antithymocyte globulin. After treatment with tacrolimus (FK506) and Psoralen plus ultraviolet light (PUVA), there was complete resolution of all clinical and laboratory evidence of GVHD. This combination may be beneficial to other patients who develop sever GVHD that is resistant to conventional therapy.