Eligible patients will be randomised to either ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) or A2VD (doxorubicin, brentuximab vedotin, vinblastine, dacarbazine).Patients will have a PET-CT scan after 2 cycles of treatment, which will be reviewed centrally. The outcome of this response assessment will be used to adapt the patient's treatment plan.
Patients with Deauville score 1-3 will have one further cycle of ABVD/A2VD
Patients with Deauville score 4 will have two further cycles of ABVD/A2VD followed by another PET-CT scan. As long as the patient does not have progressive disease, they will have involved site radiotherapy (ISRT)
Patients with Deauville score 5 will stop trial treatment and enter follow up. They will have further treatment for Hodgkin lymphoma off trial, at their treating clinician's discretion.
Patients will be followed up for a minimum of 5 years after completing treatment. They will have a scan (either CT or PET-CT, depending on the result of previous scans), and lung function tests 3 and 12 months after stopping treatment.
The following are optional exploratory elements of the trial; patients can enter the trial even if they do not wish to take part in these:
- PET-CT scan after cycle 1
- Donating up to 4 sequential blood samples for laboratory studies to increase understanding of Hodgkin lymphoma
- Donating their diagnostic tumour block for laboratory studies to increase understanding of Hodgkin lymphoma