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Chokri Ben Lamine: ASH 2026 Adult Primary ITP Guidelines – Practice-Changing Update
Chokri Ben Lamine/X
Aug 22, 2026, 13:21

Chokri Ben Lamine: ASH 2026 Adult Primary ITP Guidelines – Practice-Changing Update

Chokri Ben Lamine, Hematologist at King Faisal Specialist Hospital and Research Center, shared a post on X about a recent article by Adam Cuker et al., published in ASH Publications, adding:

“ASH 2026 Adult Primary ITP Guidelines – practice-changing update

1.Initial therapy

Consider either:

  • Rituximab, corticosteroid with or without IVIG or Thrombopoietic agent, corticosteroid with or without IVIG rather than corticosteroids alone.
  • Conditional recommendation; low-certainty evidence.

2.Diagnostic uncertainty?

  • A brief corticosteroid course with or without IVIG for equal to or less than 2 weeks may confirm treatment responsiveness before combination therapy.

3.Steroid stewardship

  • Dexamethasone 40 mg/day for 4 days, repeated for 1 – 3 cycles or prednisolone 0.5 – 2 mg/kg/day.
  • Keep total corticosteroid exposure equal to or less than 6 weeks.

4.After first-line corticosteroid failure

  • Thrombopoietic agent: strong recommendation, moderate-certainty evidence.
  • Rituximab: conditional recommendation, low-certainty evidence.
  • Rituximab may suit patients wishing to avoid chronic treatment.

5.If both are unsuitable

  • Consider a BTK inhibitor, mycophenolate mofetil, or SYK inhibitor – guided by toxicity, access, cost and patient preference.
  • Evidence remains very uncertain.

6.Splenectomy

  • Delay equal to or more than 1 year from diagnosis when feasible.
  • Vaccinate equal to or more than 2 weeks beforehand.
  • Counsel regarding lifelong sepsis and thrombosis risks.

7.Switching thrombopoietic agents

  • Reasonable for inadequate response, toxicity, comorbidities, adherence or preference.
  • Avoid treatment gaps and monitor closely.

The modern goal is not simply a ‘normal’ platelet count – it is haemostasis, reduced bleeding, better quality of life and sustained treatment-free response.

MCQ: Preferred treatment after corticosteroid failure?

  1. Prolonged prednisone
  2. Thrombopoietic agent
  3. Immediate splenectomy
  4. Azathioprine

OSCE pearl: Discuss bleeding risk, treatment burden, thrombosis or infection, reproductive plans, cost and the patient’s preference before selecting therapy.⁠”

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

Chokri Ben Lamine

Other posts featuring Chokri Ben Lamine on Hemostasis Today.

Adam Cuker ASH ASH 2026 Brenda G Shy Camila Masias Chokri Ben Lamine Cindy E. Neunert Deirdra R Terrell Donald M. Arnold Douglas B Cines Health Hematology Hemostasis Hemostasis News Hemostasis Today Honieh Sowdagar ITP James B. Bussel Jessica VandeVelde Keith R. McCrae Medicine Mirjana Mitrovic Primary ITP Rachael F. Grace Sandhya Ramanathan Panch Sara K Vesely Surbhi Shah Sylvain Audia Terrell DR thrombocytopenia thrombosis Tomas Jose Gonzalez-Lopez Vesely SK
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