American Society of Hematology 2026 guidelines for immune thrombocytopenia: initial and second-line therapy for adults with primary ITP
19 affiliations
- 1Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- 2Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- 3Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Campus, Oklahoma City, OK
- 4Department of Medicine, McMaster University, Hamilton, ON, Canada
- 5Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- 6Department of Internal Medicine, Université Bourgogne Europe, Dijon, France
- 7Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
- 8Department of Pediatrics, Weill Cornell Medical College, Cornell University, New York, NY
- 9Department of Hematology, Hospital Universitario de Burgos, Burgos, Spain
- 10Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard Medical School, Boston, MA
- 11Miami Cancer Institute, Baptist Health South Florida, Coral Gables, FL
- 12Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
- 13Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- 14Medical Faculty, University of Belgrade, Belgrade, Serbia
- 15Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY
- 16Division of Hematology/Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
- 17Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
- 18Albany, GA
- 19Topeka, KS
Abstract
Background: Since publication of the American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia (ITP), new clinical trials have been completed, and new treatments have become available.
Objective: These evidence-based guidelines from the American Society of Hematology (ASH) are a focused update of the 2019 ASH ITP guidelines, centering on treatment of adults with primary ITP.
Methods: ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The University of Oklahoma supported the guideline development process, including updating or performing systematic evidence reviews (up to 19 July 2025). The panel prioritized clinical questions and outcomes according to their importance to clinicians and patients and identified areas with new data or in which application of new methods would be of benefit. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks and the GRADE framework for multiple comparisons, to assess evidence and make recommendations, which were subject to public comment.
Results: The panel agreed on recommendations for adults with primary ITP regarding initial therapy and second-line therapy for patients who failed first-line corticosteroids. The panel also issued good practice statements on thrombopoietic agent switching and splenectomy.
Conclusions: Novel recommendations of these guidelines include (1) initial therapy with a combination of rituximab plus corticosteroids or a thrombopoietic agent plus corticosteroids rather than corticosteroids alone (conditional recommendation) and (2) a thrombopoietic agent (strong recommendation) or rituximab (conditional recommendation) for patients who failed first-line corticosteroids.
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BibTeX
@article{cuker2026american,
title = {{American Society of Hematology 2026 guidelines for immune thrombocytopenia: initial and second-line therapy for adults with primary ITP}},
author = {Adam Cuker and Deirdra R. Terrell and Honieh Sowdagar and Donald M. Arnold and Sylvain Audia and James B. Bussel and Tomás José González-López and Rachael F. Grace and Camila Masias and Keith R. McCrae and Mirjana Mitrovic and Cindy Neunert and Sandhya R. Panch and Surbhi Shah and Brenda Shy and Jessica VandeVelde and Douglas B. Cines and Sara K. Vesely},
journal = {Blood Advances},
year = {2026},
month = aug,
doi = {10.1182/bloodadvances.2026021269},
url = {https://doi.org/10.1182/bloodadvances.2026021269},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - American Society of Hematology 2026 guidelines for immune thrombocytopenia: initial and second-line therapy for adults with primary ITP
AU - Adam Cuker
AU - Deirdra R. Terrell
AU - Honieh Sowdagar
AU - Donald M. Arnold
AU - Sylvain Audia
AU - James B. Bussel
AU - Tomás José González-López
AU - Rachael F. Grace
AU - Camila Masias
AU - Keith R. McCrae
AU - Mirjana Mitrovic
AU - Cindy Neunert
AU - Sandhya R. Panch
AU - Surbhi Shah
AU - Brenda Shy
AU - Jessica VandeVelde
AU - Douglas B. Cines
AU - Sara K. Vesely
PY - 2026
DA - 2026/08/21
JO - Blood Advances
DO - 10.1182/bloodadvances.2026021269
UR - https://doi.org/10.1182/bloodadvances.2026021269
AB - Background: Since publication of the American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia (ITP), new clinical trials have been completed, and new treatments have become available. Objective: These evidence-based guidelines from the American Society of Hematology (ASH) are a focused update of the 2019 ASH ITP guidelines, centering on treatment of adults with primary ITP. Methods: ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The University of Oklahoma supported the guideline development process, including updating or performing systematic evidence reviews (up to 19 July 2025). The panel prioritized clinical questions and outcomes according to their importance to clinicians and patients and identified areas with new data or in which application of new methods would be of benefit. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks and the GRADE framework for multiple comparisons, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on recommendations for adults with primary ITP regarding initial therapy and second-line therapy for patients who failed first-line corticosteroids. The panel also issued good practice statements on thrombopoietic agent switching and splenectomy. Conclusions: Novel recommendations of these guidelines include (1) initial therapy with a combination of rituximab plus corticosteroids or a thrombopoietic agent plus corticosteroids rather than corticosteroids alone (conditional recommendation) and (2) a thrombopoietic agent (strong recommendation) or rituximab (conditional recommendation) for patients who failed first-line corticosteroids.
SN - 2473-9529
SN - 2473-9537
ER -