AbstractRuxolitinib (rux) Phase II clinical trials are underway for the treatment of high-riskJAK2-rearranged (JAK2r) B-cell acute lymphoblastic leukemia (B-ALL). Treatment resistance to targeted inhibitors in other settings is common; elucidating potential mechanisms of rux resistance inJAK2r B-ALL will enable development of therapeutic strategies to overcome or avert resistance. We generated a murine pro-B cell model ofATF7IP-JAK2with acquired resistance to multiple type-I JAK inhibitors. Resistance was associated with mutations within theJAK2ATP/rux binding site, including aJAK2p.G993A mutation. Using in vitro models ofJAK2r B-ALL,JAK2p.G993A conferred resistance to six type-I JAK inhibitors and the type-II JAK inhibitor, CHZ-868. Using computational modeling, we postulate thatJAK2p.G993A enabled JAK2 activation in the presence of drug binding through a unique resistance mechanism that modulates the mobility of the conserved JAK2 activation loop. This study highlights the importance of monitoring mutation emergence and may inform future drug design and the development of therapeutic strategies for this high-risk patient cohort.