Anti-Leukemia Immune Responses After Irradiation of Extramedullary Tumors

PRIMARY OBJECTIVES: I. To identify changes in anti-leukemia immune responses after local radiotherapy to extramedullary sites. II. Develop an annotated biospecimen panel of extramedullary leukemia biopsies prior to and after radiotherapy to examine local immune responses using transcriptional profiling, immunofluorescence and single cell analyses. III. Define changes in the T cell receptor (TCR) clonotypes, functionality and inflammatory cytokine levels in peripheral blood leukocytes and serum. IV. Correlate changes in anti-tumor immune responses with clinic-pathological variables and patient outcomes. SECONDARY OBJECTIVES: I. To assess the overall response rate (ORR= complete response \[CR\] + partial response \[PR\]) of the extramedullary tumor treated with radiation therapy. II. To assess the CR of extramedullary tumor treated with radiation therapy. III. Determine the duration of response (DOR), event-free survival (EFS). OUTLINE: Patients undergo biopsy prior to radiation therapy and 7-14 days after radiation therapy. Patients also undergo blood sample collection prior to therapy (within 7 days of starting radiation therapy), 1 and 7 days post completion of radiation therapy. Patients' photographs of the biopsy site are taken before and at 4-6 weeks post completion of radiation, and their medical records are reviewed for up to 2 years.