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Background Myelodysplastic syndromes (MDS) are hematologic malignancies that lack effective treatments, especially in cases when they evolve into leukemia.Protein phosphatase 2A (PP2A) helps regulate the cell cycle and apoptosis in MDS, leading us to explore whether and how the small-molecule PP2A inhibitor LB 1 can potentiate the chemotherapeutic activity of daunorubicin on secondary acute myeloid leukemia (sAML) evolved from MDS.