The guideline panel agreed on the recommendations (including direction and strength), remarks, and qualifications on the basis of consensus or, in rare instances, by voting, based on the balance of all desirable and undesirable consequences. All panel members reviewed and approved the final recommendations. Interpretation of strong and conditional recommendations The recommendations are labeled as either strong or condi- tional according to the GRADE approach. The words the guideline panel recommends are used for strong recommendations and the guideline panel suggests for conditional recommenda- tions. Table 2 provides the suggested interpretation of strong and conditional recommendations by patients, clinicians, and health care policy makers. Document review Draft recommendations were reviewed by all members of the panel, revised, and then made available online on 5 December 2017 for external review by stakeholders, including allied organizations, other medical professionals, patients, and the public. Ten individuals or organizations submitted comments. The document was revised to address pertinent comments. On 30 June 2018, the ASH Guideline Oversight Subcommittee and the ASH Committee on Quality approved that the defined guideline development process was followed, and on 3 August 2018, the officers of the ASH Executive Committee approved submission of the guidelines for publication under the imprimatur of ASH. The guidelines were then subjected to peer review by Blood Advances. How to use these guidelines ASH guidelines are primarily intended to help clinicians make decisions about diagnostic and treatment alternatives. Other purposes are to inform policy, education, and advocacy and to state future research needs. They may also be used by patients. These guidelines are not intended to serve or be construed as a standard of care. 