Terrell, Deirdra R.

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 including two patient representatives that 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 July 19, 2025). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and identification of areas with new data or where 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 in adults with primary ITP regarding initial therapy and second-line treatment in 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.

Abstract In 2003, the Institute of Medicine noted the need to improve workforce diversity. The American Society of Hematology (ASH) responded by developing the Minority Recruitment Initiative (MRI) to recruit diverse physicians/scientists into hematology. We evaluated the outcomes of the program. From 2004 to 2022, there were 405 awardees. Compared with national estimates, MRI awardees were less likely to discontinue their degree programs. MRI graduate student awardees had 0% attrition (97.5% confidence interval [CI], 10.6), whereas the national minority graduate student attrition was 36%. Medical student awardees had 2.2% (95% CI, 0.61-5.6) attrition, compared with the minority medical school attrition of 5.6%. Awardees were more likely than expected to pursue hematology-oncology (5.7% minority national estimate) because 14.4% (95% CI, 8.1-23.0) of medical student awardees and 88.5% (95% CI, 70.0-97.6) of early career awardees remain in the field. ASH has developed a successful program, but continued efforts are needed to advance equity in hematology.