Fecal Microbiota Transplant and Dietary Fiber Supplementation for the Treatment of Gut Graft Versus Host Disease

This phase I trial studies how well fecal microbiota transplant and dietary fiber supplementation work in treating patients with gut graft versus host disease. Fecal microbiota transplant entails inoculating donor stool into a recipient's gastrointestinal tract. Changing the gut microbiome by fecal microbiota transplant and fiber supplementation may help treat gut graft versus host disease.

OUTLINE: Patients are randomized to 1 of 4 arms.

ARM I: Patients receive upper FMT capsules orally (PO) over 2 days.

ARM II: Patients undergo lower FMT via colonoscopy on day 0.

ARM III: Patients receive upper FMT capsules PO over 2 days. Patients receive fiber supplementation PO while on study.

ARM IV: Patients undergo lower FMT via colonoscopy on day 0. Patients receive fiber supplementation PO while on study.

Patients also undergo tissue, stool, stool swabs, and blood sample collection throughout the study.

After completion of study treatment, patients are followed up for 365 days.

Eligibility Criteria:
Inclusion Criteria:

* 18 years of age or older
* History of allogeneic hematopoietic stem cell transplant in the past 100 days
* Post-engraftment, defined by time period following three consecutive days of sustained neutrophil engraftment with an absolute neutrophil count of at least 500 cells/mm\^1
* Mild to severe acute GI GvHD stage 1 as measured by the modified Glucksberg criteria and averaged over 3 consecutive days in the last week. In patients who have already had GI biopsy, biopsy histology must be compatible with GVHD, although biopsy is not required

Exclusion Criteria:

* History of previous serious adverse events associated with FMT
* History of bowel perforation
* History of bowel resection
* History of intestinal obstruction
* History of gastric bypass
* History of diverticulitis
* History of inflammatory bowel disease (i.e. Crohn's disease and ulcerative colitis)
* History of celiac disease confirmed by serologic testing or small bowel biopsy
* History of severe dietary allergy as designated by World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System grade 2 or more
* Current evidence of mechanical obstruction of the bowel
* Subjects who are cytomegalovirus (CMV) seronegative at the time of enrollment as indicated by clinical testing unless the fecal microbiota transplant (FMT) donor is CMV seronegative with negative plasma polymerase chain reaction (PCR) assays for CMV.
* Known allergies to loperamide, sodium chloride, glycerol, theobroma oil, hide bovine gelatin, sodium lauryl sulfate, colorants FD\&C, titanium dioxide, polyethylene glycol, sodium sulfate, sodium bicarbonate, sodium phosphate, benzalkonium chloride, disodium EDTA or potassium chloride.
* Currently pregnant, planning to become pregnant or breastfeeding during the study period. Women of childbearing potential (those who are not post-menopausal or post-hysterectomy) must be negative for pregnancy per urine pregnancy test at enrollment
* Individuals with the ability to conceive children who are not willing to abstain from sexual activity or use an effective form of birth control during the duration of the study
* Unwilling or unable to participate in study procedures including oral intake of FMT, colonoscopy, fiber supplementation, collection of stool samples and completion study surveys
* Cannot reasonably and safely participate in the study in the opinion of the investigators