All patients will start treatment by receiving 2 cycles of the monoclonal antibody, avelumab, this will last about 2 months. Patients will have a PET-CT scan after these 2 cycles to assess their response to treatment. 

Patients will then go on to receive standard treatment for Hodgkin lymphoma which is a response adapted approach whereby all patients receive 2 cycles of ABVD chemotherapy followed by an interim PET scan. For those with a negative PET result (which shows the patient has responded well to treatment), 4 cycles of AVD chemotherapy are given. Patients with a positive PET result (which shows the patients has not responded as well to treatment) go on to receive BEACOPP chemotherapy. 

Key Inclusion Criteria

• Aged 16-60 (inclusive)

• Previously untreated classical Hodgkin lymphoma

• High risk stage II, stage III or IV disease

• ECOG performance status 0-1

• Adequate bone marrow and liver function 

Key Exclusion Criteria

• Nodular lymphocyte predominant Hodgkin lymphoma

• Requirement for urgent treatment due to life-threatening complications of the disease

• Women who are pregnant or breastfeeding

• History of colitis, inflammatory bowel disease or pneumonitis

• Patients with autoimmune disorders (some exclusions apply)

• Positive serology for hepatitis B or C 

• Known HIV infection

• Major surgery within 4 weeks prior to registration

• Active infection requiring systemic therapy

• Non-haematological malignancy within the past 3 years 

• Previously treated haematological malignancy

• Any uncontrolled medical condition which can impair delivery of planned immunochemotherapy

• Patient not deemed suitable for ABVD/AVD/escalated-BEACOPP/BEACOPP-14