BIRC5 and acute myeloid leukemia: Importantly, ERK and its downstream signaling mediator MSK were obviously constitutively activated (i.e phosphorylated) in six paired CD34+ AML patients, suggesting that activation of ERK and MSK (as observed by phosphorylation levels of these targets) was intrinsic and spontaneous in such cells and was required for the expression of survivin in LSCs (Figure 10).