ASH — ASH 2026 Guidelines for Initial and Second-Line Therapy in Adults With Primary Immune Thrombocytopenia

For adults with primary ITP requiring initial therapy, ASH 2026 conditionally suggests rituximab plus corticosteroids (with or without IVIG) or a thrombopoietic agent plus corticosteroids (with or without IVIG) rather than corticosteroids alone when those agents are available and appropriate. If rituximab/TPO agents are not available options, corticosteroids (with or without IVIG) remain appropriate. After failure of first-line corticosteroids, a thrombopoietic agent is strongly recommended and rituximab is a conditional option. Shared decision-making, toxicity, access and patient preference matter.