Blood (ASH) 'Under Review': What Each Status Means and When to Expect a Decision

Before the paper reaches external reviewers, a Blood senior editor or associate editor evaluates whether the hematology-significance warrants Blood's selective editorial slots. About 65 to 75 percent of submissions are rapidly rejected without external peer review. A desk rejection most often means the editor concluded that the work would fit better at a sister ASH journal (Blood Advances for clinical-research cascade, Blood Cancer Discovery for cancer-research focus, Blood Cancer Journal for open-access cascade) or that the hematology-priority bar is not met. Scope misfit and framing problems drive most early rejections, not weak methodology.

The Blood editorial office confirms files are complete: manuscript with figures embedded, supplementary information separate, CONSORT checklist for clinical trials (required), reporting checklists where applicable (STROBE for observational studies, ARRIVE for animal work, MIQE for quantitative PCR), cover letter directed to the editor, conflict-of-interest declarations, ethics-statement documentation, IRB approvals, trial-registration documentation (required for clinical trials), and data-sharing statement.

The Blood senior editor or associate editor reads the paper and evaluates hematology-significance (priority for ASH readership), scientific rigor, and ASH family routing. The desk-screen evaluation focuses on priority and scope rather than data quality or technical issues.

In parallel with the primary editor's read, ambiguous-fit papers are discussed across the ASH editorial team where peer senior editors weigh in on whether the paper would fit better at Blood flagship or at sister ASH journals (Blood Advances, Blood Cancer Discovery, Blood Cancer Journal). This editorial-team discussion runs alongside the desk-screen and adds 3 to 5 days to the timeline that is invisible to the author in the portal.

Blood associate editors typically invite at least 2 (typically 3) external experts in the field. The recruitment window can take 7 to 14 days because reviewers with topic-matched hematology subspecialty expertise are scarce.

Once reviewers agree to review, the typical Blood peer-review cycle lasts 3 to 4 weeks per reviewer per ASH guidance. Reviewers are asked to evaluate hematology-significance, scientific rigor, and reproducibility. Reviewer reports for Blood tend to be thorough; 2000 to 4000 word reports are typical given the typical-3-reviewer model.

After reports return, the associate editor synthesizes them and the senior editor makes the final recommendation. First decisions can move quickly when scope and reviewer matching are straightforward, but complex or specialized papers can take longer.

• Rejection within 1 to 5 days: Administrative issue or immediate scope mismatch.
• Rejection within 5 to 14 days: Blood editor desk rejection per the 65 to 75 percent figure.
• Still Under Review after 3 weeks: Strong signal. Paper passed the Blood editor filter.
• Still Under Review after 10 weeks: Reviewer-recruitment or reviewer-report delay. A polite inquiry via the ScholarOne portal is appropriate.
• Status changes to "Decision Pending": Reports are in; expect a decision within 1 to 2 weeks.

This is the most common anxiety we hear from Blood authors during the active editorial window. The honest answer: no, 8 weeks at Under Review puts you in the normal middle of Blood's typical post-screen review distribution for the typical-3-reviewer model. Reports may already be in editorial synthesis with the associate editor preparing the recommendation. Most reviewer-driven delays come from reviewer-recruitment timing for hematology subspecialty experts rather than slow reviews because the 3-reviewer model takes longer to recruit than the 2-reviewer norm at many specialty journals. If the portal still says Under Review at the 10-week mark, the most likely explanation is that one of the assigned reviewers asked for an extension and the associate editor granted it. This is normal practice at Blood.

What you should NOT do during the 8-to-10-week window is email the editorial office. Blood associate editors are managing 30+ active papers; an inquiry at 8 weeks adds friction without accelerating the timeline.

If your Blood paper is rejected after review, the natural cascade depends on what the reviewers and editor cited:

Blood Advances is the natural ASH cascade for clinical-research hematology papers where the priority bar of Blood flagship is not met but the rigor is high. ASH supports manuscript-transfer with reviewer reports preserved.

Blood Cancer Discovery is the ASH cascade for cancer-research hematology papers (AACR co-publication).

Blood Cancer Journal is the open-access hematology-cancer cascade.

Leukemia is the external Springer Nature hematology cascade for leukemia-focused work. Nature Portfolio operates independently from ASH; the Nature Portfolio Manuscript Tracking System at mts-leu.nature.com handles submission; leukemia@nature.com handles publisher-level inquiries.

Haematologica is the European Hematology Association journal cascade for general-hematology research.

Journal of Clinical Oncology (JCO) is the ASCO cascade for clinical-oncology hematology research (especially leukemia, lymphoma, myeloma clinical trials).

ASH asks reviewers at Blood to evaluate four things specifically. The table below maps each to actionable preparation.

In our pre-submission work with Blood-targeted manuscripts, three named patterns generate the most consistent reviewer concerns and the most common reasons papers miss the editorial bar or fail the desk screen.

Narrow-priority framing flagged at desk screen. When the introduction frames the work too narrowly without broader-hematology priority, Blood editor desk rejection within 5 to 14 days is common. The strongest manuscripts frame the introduction around a broader-hematology question the findings address.

Subspecialty-methodology gaps surface as reviewer concerns. When subspecialty-specific methods documentation is thin (especially for flow cytometry panels, mass cytometry, single-cell hematopoiesis, clinical-trial sample-size justification, or transplant outcome adjudication), reviewers consistently request expanded methods sections. The strongest revisions add subspecialty-matched methods detail.

ASH cascade offers from senior editor. When the senior editor concludes the work is rigorous but the priority bar of Blood flagship is not met, transfer offers to Blood Advances (clinical-research open-access cascade), Blood Cancer Discovery (cancer-research), or Blood Cancer Journal (open-access cancer-hematology) are common. ASH editors take these transfers seriously.

This page was created from ASH's public peer review policies at ashpublications.org/blood/pages/peer-review, Blood manuscript submission documentation (at-least-2 typically-3 reviewer model, 3 to 4 week reviewer target, priority-and-scope desk-rejection criteria, subspecialty-matched reviewer recruitment), and Manusights pre-submission review experience with Blood-targeted manuscripts.

For the ASH hematology landscape beyond Blood flagship, see Blood Advances (clinical-research open-access cascade), Blood Cancer Discovery (cancer-research AACR co-publication), Blood Cancer Journal (open-access cancer-hematology), and external hematology alternatives (Leukemia, Haematologica, JCO, NEJM for top-tier clinical hematology trials). The choice across these titles depends on whether the central contribution is top-tier ASH hematology priority (Blood), ASH open-access clinical-research (Blood Advances), cancer-research hematology (Blood Cancer Discovery), open-access cancer-hematology (Blood Cancer Journal), or external hematology (Leukemia, Haematologica, JCO, NEJM).

Reviewers at Blood typically draw from subspecialty experts in leukemia, lymphoma, myeloma, hemostasis, transplantation, or benign hematology. Editors screen and triage manuscripts before any external reviewer sees them, and preparing a response template that addresses subspecialty-matched methodology and broader-hematology priority accelerates revision rounds substantially.

For a pre-upload check of your manuscript against the Blood hematology-priority bar before submission, our Blood pre-submission diagnostic flags the framing and subspecialty-methodology weaknesses most likely to surface in reviewer reports.