Speaking from the 2018 European School of Hematology (ESH) Clinical Updates on Acute Leukemias, held in Budapest, Hungary, Charles Mullighan, MBBS (Hons), MSc, MD, from St. Jude Childrens Research Hospital, Memphis, TN, discusses ways of improving the outcomes of patients suffering from B- cell acute lymphoblastic leukemia (ALL) and other B-cell disorders using CAR T-cell therapy. Therapy should be offered as early as possible before relapse has occurred and before initial diagnosis to avoid the effects of high-dose chemotherapy. B-cell ALL target antigens including CD19 have also been proven to demonstrate efficacy in ALL patients and should be considered when choosing immunotherapy. Dr Mullighan also gives his insights on how to increase the effectiveness of T-cell ALL therapies by using genomic information and more advanced engineering platforms.