It may seem contradictory that PERK/eIF2α/ATF4 pathway participated in both ER stress-induced apoptosis and autophagy, but recent studies in selenite-treated leukemia NB4 cells indicated that it was the PERK/eIF2α/ATF4 axis that itself had modulated the switch between autophagy and apoptosis with the assistance of p38.88 It was reported in the same study that PERK modulated the phosphorylation of p38, which affected the target selection of ATF4 to mediate the switch between apoptosis and autophagy. Here, ATF4 is linked to leukemia.