In this issue of Blood, Cheng et al have identified a novel and previously unrecognized nuclear function of double-stranded RNA-activated protein kinase (PKR) in the pathogenesis of acute myeloid leukemia (AML). Increased PKR promotes genomic instability and is associated with inferior outcomes in both AML and a mouse model of myelodysplastic syndrome (MDS) and leukemia. Thus, nuclear PKR has an oncogenic function and can be a novel therapeutic target to prevent leukemia progression or relapse and improve clinical outcomes.