• Clinical activity will be monitored at 3 month intervals after the initiation of sirolimus until 2 years after the initiation of sirolimus
  
• Clinical activity will be determined by ability to discontinue immunosuppression with resolution of all reversible CGVHD manifestations and no additional systemic therapy before or after the 2 year time-point
  
• The primary endpoint will be evaluated at 2 years after enrollment
  
• Patients will remain enrolled until death or closure of the study
  

• Monitoring the clinical response based on completed chronic GVHD staging sheets, patient photographs, care provider documentation and physical therapy evaluations
  
• Duration of treatment with prednisone
  
• Treatment failure defined as inability to taper immunosuppression or need to begin additional systemic treatment for chronic GVHD
  
• Monitoring toxicities including renal insufficiency, hyperlipidemia and post-transplant microangiopathic hemolytic anemia
  
• Overall survival
  
• Cumulative incidence of secondary systemic treatment for chronic GVHD
  
• Cumulative incidence of death without recurrent malignancy
  
• Cumulative incidence of recurrent malignancy
  

The purpose of this trial is to study the effectiveness of an immunosuppressive drug, sirolimus, in the treatment of chronic graft versus host disease in combination with prednisone. Graft versus host disease (GVHD) is a common complication in patients who have received blood or marrow transplantation from a related or unrelated donor. Chronic GVHD occurs approximately 100 days after transplantation and is the result of the donor immune system recognizing the patient's tissues as foreign and creating harmful effects on the patient';s organs. We hope the use of sirolimus will decrease the significant disabling effects and deaths caused by chronic GVHD.