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ASH 2025 Nonmalignant Hematologic Disorders

CE / CME

Emerging Data and Clinical Implications in Nonmalignant Hematologic Disorders: ASH 2025 Highlights

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 1.00 Nursing contact hour

Released: February 20, 2026

Expiration: August 19, 2026

Hanny Al-Samkari
Hanny Al-Samkari, MD
Joseph J. Shatzel
Joseph J. Shatzel, MD, MCR
CME/CE Information

Activity

Progress
1 2 3
Course Completed

Multicenter Cohort Study of ICI-ITP: Study Design

Hanny Al-Samkari, MD:
Immune checkpoint inhibitor (ICI)–induced ITP is a feared complication of ICIs, which are very commonly used in oncology. Presented at ASH 2025 was a retrospective study of more than 86,000 adults who received ICI therapy at 29 hospitals across 7 major academic cancer centers. Investigators aimed to determine how frequently patients develop ICI-ITP because its incidence is currently unknown. Prior to this study, there was not much information about the natural history of this disease, the likelihood of remission, or how patients respond to certain therapies. Classical hematologists at each site adjudicated the cases, and there was a very intensive manual chart review done by physicians and their research staff. After screening and exclusion, the analysis yielded 214 eligible cases and 428 eligible controls.7

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Multicenter Cohort Study of ICI-ITP: Incidence

Hanny Al-Samkari, MD:
The overall incidence of ICI-ITP was 0.25% and was highly consistent across sites, ranging from 0.15% to 0.30%. The median time to ICI-ITP onset following ICI initiation was 8 weeks, consistent with what is seen in the clinic.7

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Multicenter Cohort Study of ICI-ITP: Baseline Characteristics and Risk of ICI-ITP

Hanny Al-Samkari, MD:
The independent risk factors for developing ICI-ITP were identified as receiving combination ICI therapy, additional immune-related AEs (eg, hypothyroidism, colitis), stage 4 cancer, which is not surprising given the high degree of immune dysregulation, and a baseline platelet count <150 x 109/L, suggesting that these patients may already have been in a persistent, isolated, mild thrombocytopenia, a smoldering pre-ITP state.7

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Multicenter Cohort Study of ICI-ITP: Management and Recovery

Hanny Al-Samkari, MD:
Patients were treated with glucocorticoids, IVIG, and TPO-RAs. The treatment response was relatively similar irrespective of the treatment used. Approximately three quarters of all patients (75.2%) recovered with treatment at 180 days. The median time to recovery was 2.3 weeks.7

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Multicenter Cohort Study of ICI-ITP: ICI Rechallenge

Hanny Al-Samkari, MD:
One common question in practice is whether ITP returns if immune checkpoint blockade is restarted. This study found that it does, but only in 30% of cases. Therefore, 70% of patients do not experience ICI-ITP again, even when they restart their ICI. When people were transitioned from combination ICI therapy to single-agent ICI, the change reduced the risk of recurrence.7

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Multicenter Cohort Study of ICI-ITP: ICI-ITP and Mortality

Hanny Al-Samkari, MD:
Investigators also found that patients with moderate or severe ICI-ITP had higher all-cause mortality rates than those who did not develop ICI-ITP or developed mild ICI-ITP. The hazard ratio for all-cause mortality with ICI-ITP vs no ICI-ITP was 1.65.7

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Multicenter Cohort Study of ICI-ITP: Summary

Hanny Al-Samkari, MD:
The authors of this study concluded that the incidence of ICI-ITP is approximately 1 in 400 patients receiving an ICI, higher in patients receiving combination ICI therapy, and lower in patients receiving single-agent ICI. More than 75% of patients recovered from ICI-ITP. The most common treatments were glucocorticoids, IVIG, and TPO-RAs, without much difference in efficacy. Rechallenge resulted in ICI-ITP recurrence in only 30% of patients. Overall, this study was helpful in defining the rate of ICI-ITP and how patients respond to treatment.

Joseph J. Shatzel, MD, MCR:
I have encountered this clinical entity, and the incidence reported does seem to reflect my personal experience. I was surprised by the mortality outcomes. Patients with severe thrombocytopenia do experience poor outcomes, so continuing treatment certainly warrants concern.

Hanny Al-Samkari, MD:
I agree. The mortality data need to be confirmed prospectively, but this will not be easy to do. 

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