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Abdul Mannan: ASH 2026 Guidelines – New Treatment Approach for Adult ITP
Abdul Mannan/LinkedIn
Sep 1, 2026, 07:22

Abdul Mannan: ASH 2026 Guidelines – New Treatment Approach for Adult ITP

Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn about a recent article by Adam Cuker et al., published in Blood Advances, adding:

“Steroids alone are no longer the assumed first move in adult ITP.

But ASH 2026 is not giving us a licence to treat every low platelet count with a drug cocktail.

The new guideline shifts the conversation:

  • If an adult with primary ITP needs initial treatment, consider steroid, rituximab or steroid and a thrombopoietic agent
  • This is conditional, with low-certainty evidence
  • After steroid-only first line fails, a thrombopoietic agent is the one strong, moderate-certainty recommendation
  • Rituximab remains an option when a time-limited course matters more than long-term medication
  • BTK inhibition, SYK inhibition and MMF sit further down the list because the evidence is thin or indirect

The best sentence in the guideline may be what it does not answer:

  • Which first-line combination should we choose?
  • How long should TPO treatment continue?
  • What comes next after upfront combination therapy?

So the shift is real. But this is a call for better shared decisions, not protocol autopilot.

My take:

Widen the first-line discussion.

Keep bleeding risk, thrombosis risk, infection and vaccine plans, access, and patient goals in the room.

Are you already using an upfront combination in adult ITP?”

Title: American Society of Hematology 2026 Guidelines for Immune Thrombocytopenia (ITP): Initial and Second-Line Therapy in Adults with Primary ITP

Authors: Adam Cuker, Deirdra R Terrell, Honieh Sowdagar, Donald M Arnold, Sylvain Audia,James B. Bussel, Tomas Jose Gonzalez-Lopez, Rachael F. Grace, Camila Masias, Keith R. McCrae, Mirjana Mitrovic, Cindy E. Neunert, Sandhya Ramanathan Panch Surbhi Shah, Brenda G Shy, Jessica VandeVelde, Douglas B. Cines, Sara K Vesely

Abdul Mannan: ASH 2026 Guidelines - New Treatment Approach for Adult ITP

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Abdul Mannan Adam Cuker adult ITP ASH 2026 Bleeding Risk Blood Advances Brenda G Shy BTK inhibitors Camila Masias Cindy E. Neunert Clinical Guidelines Clinical Practice Corticosteroids Deirdra R Terrell Donald M. Arnold Douglas B Cines evidence-based medicine Hematology Hematology Research Hemostasis Hemostasis News Hemostasis Today Honieh Sowdagar Immune thrombocytopenia ITP James B. Bussel Jessica VandeVelde Keith R. McCrae Mirjana Mitrovic Mycophenolate Mofetil Platelet disorders Rachael F. Grace rituximab Sandhya Ramanathan Panch Surbhi Shah Sara K Vesely Shared Decision Making SYK Inhibitors Sylvain Audia thrombocytopenia Thrombopoietic Agents thrombosis risk Tomas Jose Gonzalez-Lopez TPO-receptor agonists
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