Patients with Philadelphia chromosome-like B-cell lymphoblastic leukemia (Ph-like or BCR-ABL1-like B-ALL) experience high relapse rates and are difficult to cure with conventional chemotherapy. 1,2 The Ph-like ALL subtype comprises 15-25% of B-ALL in older children and adolescents/young adults (AYAs) and 20-40% of cases in older adults. 1,2 Ph-like ALL is driven by alterations in cytokine receptor signaling pathway genes that induce oncogenic kinase signaling, suggesting therapeutic potential for kinase inhibitors. 1 Approximately 50% of Ph-like ALL has rearrangements in CRLF2 (cytokine receptor-like factor 2), often with concomitant JAK2 or JAK1 point mutations, which leads to constitutive JAK/STAT signaling targetable by JAK inhibitors (JAKi) such as ruxolitinib. JAK2 and EPOR translocations comprise an additional 8-12% of Ph-like ALL in children/AYAs and adults.1-3 JAK2-or EPOR-rearranged ALLs are also characterized by hyperactive JAK/STAT signaling and are potentially very sensitive to JAK inhibition. 3,4 While JAKi addition to multi-agent chemotherapy is under current clinical investigation in children and adults with newlydiagnosed or relapsed CRLF2-R/JAK-mutant Ph-like ALL via early-phase trials (clinicaltrials.gov identifier 02723994, 03117751, 02420717), whether this therapeutic strategy haematologica 2018; 103:e427

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The development of autoimmune blood cell cytopenias is a potentially life-threatening complication of solid organ transplantation, resulting from T-cell dysregulation from immunosuppressive medications. Conventional treatment with corticosteroids and IVIgG is often unsuccessful as these therapies are unlikely to overcome the T-cell dysregulation. We describe two patients who developed severe autoimmune cytopenias after solid organ transplantation. They had limited response to conventional medications, but had complete resolution of autoimmunity upon transition of immunosuppression from tacrolimus to sirolimus. Altering the immunosuppressive regimen to modify T-cell dysregulation may be beneficial for patients who develop post-transplant autoimmune disease and allow continued preservation of allograft.