Multiple counterregulatory mechanisms have been identified in B-cell precursors that operate to regulate cell survival and growth, thereby ensuring the orderly development and differentiation of B-cells. Inappropriate apoptosis may underlie the pathogenesis of immunodeficiencies, as well as pathogenesis and drug/radiation resistance of human leukemias and lymphomas, which makes control of apoptosis an important potential target for therapeutic interventions. Therefore, identification of the molecular regulators of apoptosis is an area of intense investigation. Bruton's tyrosine kinase (BTK) is the first tyrosine kinase to be identified as a dual-function regulator of apoptosis, which promotes radiation-induced apoptosis but inhibits Fas-activated apoptosis in B-cells. BTK functions in a pro-apoptotic manner when B-cells are exposed to reactive oxygen intermediates, at least in part, by down-regulating the anti-apoptotic activity of STAT-3 transcription factor. In contrast, BTK associates with the death receptor Fas and impairs its interaction with Fas-associated protein with death domain (FADD), which is essential for the recruitment and activation of FLICE by Fas during the apoptotic signal, thereby preventing the assembly of a pro-apoptotic death inducing signaling complex (DISC) after Fas-ligation. The identification of BTK as a dual-function regulator of apoptosis will significantly increase our understanding of both the biological processes involved in programmed cell death and the diseases associated with dysregulation of apoptosis. New agents with BTK-modulatory activity may have clinical potential in the treatment of B-cell malignancies (in particular acute lymphoblastic leukemia, the most common form of childhood cancer), as well as B-cell immunodeficiencies.