Dietary and Topical Magnesium Replacement or Supplementation in Patients With Lymphoma

PRIMARY OBJECTIVE:

I. Assess if dietary replacement with magnesium rich foods and topical magnesium replacement improves serum magnesium levels in patients with a history of a lymphoproliferative disorder, not on active myelosuppressive chemotherapy, and have a serum magnesium levels 1.5 - 1.9 mg/dL.

SECONDARY OBJECTIVES:

I. Evaluate the compliance of a diet rich in magnesium as well as compliance with topical magnesium replacement in lymphoma patients who have completed therapy and are in remission.

II. Assess feasibility of enrolling patients with a history of lymphoproliferative disorder, not on active treatment with low magnesium levels.

III. Assess tolerability and toxicity of a magnesium rich diet with and without topical magnesium replacement.

EXPLORATORY OBJECTIVES:

I. Assess quality of life in patients receiving magnesium replacement with diet and/or topical magnesium.

II. Evaluate whether magnesium replacement strategies are equally effective between ethnicities.

OUTLINE:

CYCLE 1: Participants consume magnesium rich foods orally (PO) daily for 28 days.

CYCLE 2: Participants with a magnesium level between 1.5-2.1 mg/dL at the end of cycle 1 are assigned to Arm I. Patients with a magnesium level between 2.2-2.3 mg/dL at the end of cycle 1 are assigned to Arm II. Patients with a magnesium level < 1.5 mg/dL at the end of cycle 1 go off study.

ARM I: Participants continue consuming magnesium rich foods PO daily and apply Ancient Minerals Magnesium Lotion topically daily for 28 days.

ARM II: Participants continue consuming magnesium rich foods PO daily for 28 days.

Inclusion criteria

PRE-REGISTRATION - INCLUSION CRITERIA:

• Age >= 18 years
• Currently have or have had in the past the diagnosis of any type of lymphoma
• If previously treated, the patient must be off myelosuppressive chemotherapy with no planned chemotherapy for >= 2 months. Patients with lymphoproliferative disorders being observed (i.e., never treated) or those on rituximab (or equivalent) maintenance or chronic oral therapies such as BTK inhibitors, venetoclax, tazemetostat, or corticosteroids are also eligible
• Able to eat a full range of solid food and liquids and tolerate seeds/nuts
• Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0, 1, or 2
• Provide written informed consent
• Able to recollect dietary intake for the prior 24 hours in order to complete a one-day food record with assistance from a dietitian at each study visit
• Willing to be seen at the enrolling institution at baseline, and at 4 weeks and 8 weeks (end of treatment) in person or by video/phone
• Willing to have a blood magnesium checked every 2 weeks x 4 at any Mayo Clinic site
• Ability to complete questionnaire(s) by themselves or with assistance

REGISTRATION - INCLUSION CRITERIA:

• Magnesium level of 1.5 - 1.9 mg/dL (obtained =< 5 days prior to registration)

Exclusion criteria

PRE-REGISTRATION - EXCLUSION CRITERIA:

• Cannot eat normal table food by mouth. NOTE: Patients with any form of feeding tube or a swallowing disorder are not eligible
• Have taken dedicated magnesium supplements (i.e. magnesium oxide) or intravenous (IV) magnesium =< 28 days prior to pre-registration. Note: If patient is already on a multivitamin containing -magnesium, they may be enrolled, but the brand should not be changed during the 8 weeks on study
• Co-morbid systemic illnesses such as active infection or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
• Patients with significant gut malabsorptive conditions (such as inflammatory bowel disease or others at the discretion of the investigator) will be excluded as well as patients with chronic kidney disease stage 3b or greater (estimated glomerular filtration rate [eGFR] < 45)
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Receiving any other investigational agent for lymphoma or any other disease
• Active other malignancy requiring treatment that would interfere with the assessments of this study
• Major surgery other than diagnostic surgery =< 4 weeks prior to pre-registration
• Have an allergy to nuts
• Patients with active skin lymphoma or rashes that would preclude lotion testing
• Have taken antibiotics =< 7 days prior to pre-registration