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

Blood operates the ASH Editor + associate editor model. The senior handling editor at Blood reads the entire paper and evaluates hematology-significance, scientific rigor, and ASH family routing. Blood's editorial team includes senior editors with hematology clinical-research backgrounds; an associate editor at Blood typically handles 30 to 50 manuscripts per quarter and spends 30 to 90 minutes on the initial read. At the discretion of the journal's Editors, a manuscript may be rapidly rejected without external peer review if it is deemed uncompetitive or outside the scope of the journal. Most articles are rejected on grounds of insufficient priority or lack of relevance to hematology, not data quality or technical issues.

Blood editorial culture is decisive: scope misfit and framing problems drive most early rejections, not weak methodology. Papers that pass the Blood editor desk screen have cleared the steepest filter in ASH hematology publishing.

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.

• Do not email the editorial office during the first 6 weeks unless an urgent ethics issue surfaces.
• Do not submit the paper anywhere else while it is Under Review at Blood. ASH has explicit prohibitions on dual submission.
• Prepare a point-by-point response template for likely reviewer concerns: hematology-significance, scientific rigor, CONSORT compliance, reproducibility.
• If you have related work submitted elsewhere or recently published, prepare disclosure language for when revisions are requested.
• Read recent Blood research articles in your subfield to calibrate the current editorial bar.

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 review work with Blood manuscripts, we have reviewed 50+ manuscripts targeting Blood, Blood Advances, hematology, leukemia, lymphoma, myeloma, hemostasis, transplantation, and clinical hematology journals. Of the 100 manuscripts our team reviewed across hematology and translational-oncology venues, the highest-leverage factor was whether the manuscript made hematology priority unavoidable in the title, abstract, first figure, and cover letter. A technically strong paper can still look wrong for Blood if the hematology consequence is implied instead of argued.

Blood hematology-priority gap in the opening. Manusights internal analysis identifies a repeated pattern where the data are serious, but the opening reads like general cancer biology, immunology, cell biology, or clinical methods work. Blood reviewers and editors need to see why the finding changes a hematology question, not merely why it uses blood, marrow, leukemia cells, or immune populations. The fix is to make the hematology consequence visible in the abstract, first paragraph, and first figure legend.

Check whether your Blood hematology-priority signal is visible →

Blood subspecialty-method detail too thin for expert review. A second pattern is a manuscript that states the right hematology question but leaves methods underexplained for the subspecialty reviewer. This often appears in flow cytometry panel design, gating strategy, single-cell processing, clinical-trial sample-size justification, transplant outcome adjudication, thrombosis endpoints, or image quantification. Stronger submissions move the audit trail into the methods and supplementary files before review begins.

Check if your Blood methods package is reviewer-ready →

Blood Advances or specialty-journal route hidden in the decision logic. A third pattern is a paper that is rigorous but not flagship-priority for Blood. If editor or reviewer comments praise the data but question general hematology importance, the author should not only ask whether to appeal. The better question is whether Blood Advances, Blood Cancer Discovery, Haematologica, Leukemia, or a subspecialty clinical venue would preserve momentum with less priority friction. Source limitation: our observations come from Manusights pre-submission and revision-support work, not from private Blood editorial records. We do not train on private author files, and Manusights offers a 60-day money-back guarantee for eligible review orders when the service does not meet the stated scope.

Check your Blood cascade response plan →

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.