Hodgkin Lymphoma Treatment and Testing Updates from ASH 2025

In this article, you’ll learn updates from the 2025 American Society of Hematology (ASH) meeting that may shape how doctors monitor and choose a first treatment for people with Hodgkin lymphoma, especially advanced-stage disease. 

PET-guided plan to use less chemotherapy

A phase 2 study tested a plan to reduce chemotherapy for people with newly diagnosed advanced-stage classical Hodgkin lymphoma, or bulky stage I to II disease in the chest. The median age of patients was 31. Just over half were male (52%), and 48% were female. 

The enrolled patients started with three cycles of four medicines: brentuximab vedotin (Adcetris, Pfizer), pembrolizumab (Keytruda, Merck), doxorubicin, and dacarbazine. After cycle 3, everyone had a PET scan. A PET scan is an imaging test that shows how active the lymphoma is. If the PET showed significantly reduced lymphoma, people could stop the chemotherapies and continue with only brentuximab vedotin plus pembrolizumab. 

All 25 people in the study had a PET response good enough to stop the chemotherapies. They finished with three more cycles of only brentuximab vedotin plus pembrolizumab. At the end of treatment, 88% of patients were in complete remission. At a median of 11.2 months of follow-up, there were no reported cases of patients’ lymphoma getting worse. The most common side effects from treatment were nausea, ALT increase signaling a stressed liver, fatigue, and hair loss. 

This study matters because many people with Hodgkin lymphoma are young. If doctors can safely use less chemotherapy, it may lower the chance of long-term side effects. 

Read this abstract: Interim PET-adapted de-escalation chemotherapy regimen for advanced stage classical Hodgkin lymphoma using brentuximab vedotin, pembrolizumab, doxorubicin, and dacarbazine: Phase 2 study  

Three years later, comparing nivolumab-AVD to brentuximab vedotin-AVD

S1826 is a large phase 3 trial for people aged 12 and older with stage III to IV classical Hodgkin lymphoma. It compared two first treatment options for six cycles:

• Nivolumab (Opdivo, Bristol Myers Squibb) plus AVD
• Brentuximab vedotin plus AVD

AVD is doxorubicin, vinblastine, and dacarbazine. 

At about 3 years, progression-free survival was 91% with nivolumab-AVD and 82% with brentuximab vedotin-AVD. Progression-free survival is the percentage of patients who were alive without lymphoma progression at that time point. The benefit was shown in many groups, including teens and seniors. No new safety concerns were reported. 

This study supports nivolumab-AVD as a top first treatment choice for many people with advanced Hodgkin lymphoma. 

Read this abstract: 3-year follow-up of the S1826 study confirms improved progression-free survival with nivolumab-AVD compared to brentuximab vedotin-AVD in advanced stage classic Hodgkin lymphoma

Five years of follow-up for BrECADD vs eBEACOPP 

Phase 3 of the HD21 trial included 1,500 adults ages 18 to 60 with newly diagnosed advanced-stage classical Hodgkin lymphoma. It compared two PET-guided regimens:

• BrECADD, which includes brentuximab vedotin plus several chemotherapy medicines
• eBEACOPP, a long-used, more intensive chemotherapy regimen

Treatment length was adjusted using a PET scan after two cycles. After 5 years since starting treatment, progression-free survival was 93.6% with BrECADD and 90.6% with eBEACOPP. These findings support BrECADD as a strong first treatment option for some adults and show why long-term follow-up is important. 

Read this abstract: Final analysis of the Phase III GHSG HD21 trial: PET-guided brecadd vs. ebeacopp in advanced-stage classical Hodgkin lymphoma

Comparing PET-guided chemotherapy plans across trials

This study combined data from four clinical trials and compared two common PET-guided starting plans for adults with advanced-stage classical Hodgkin lymphoma:

• Start with two cycles of eBEACOPP, then adjust based on PET scan
• Start with two cycles of ABVD, then adjust based on PET scan 

They found that eBEACOPP was linked with better 5-year progression-free survival (87.0%) than ABVD (79.5%). These insights are important because they can help inform your decision-making process while selecting a treatment for Hodgkin lymphoma. 

Read this abstract: PET-adaptive beacopp- versus ABVD-based therapies for advanced-stage (AS) classic Hodgkin lymphoma (cHL): Survival comparisons leveraging a multi-state model and analyzing the impact of a-hipi scores across the disease course 

CtDNA blood testing may predict risk better than PET

Researchers studied ctDNA in people from the S1826 study. CtDNA is a blood test that looks for tiny pieces of lymphoma DNA. The team measured how much ctDNA was present and how much it dropped during treatment. 

CtDNA results early in treatment were strongly linked to outcomes. People who still had detectable ctDNA at the end of treatment had worse 3-year progression-free survival than those who did not. CtDNA was also found to be a better test than a PET scan. 

In the future, a blood test like ctDNA may help doctors spot higher-risk cases sooner and adjust care earlier. More studies are needed before this becomes part of standard care.

Read this abstract: Circulating tumor DNA analyses of molecular tumor burden are superior to PET-assessed responses in patients with advanced stage classic Hodgkin lymphoma treated on SWOG S1826 

A-HIPI may be a better risk score than IPS in today’s treatment

Hodgkin lymphoma doctors have used the International Prognostic Score (IPS) for many years to predict how well treatments may work for patients. However, IPS does not separate risk well for modern treatments. The newer A-HIPI score uses more detailed clinical and lab information to better estimate how patients may respond to therapies.  

In adults treated in the S1826 study, A-HIPI sorted people into clearer risk groups than IPS. People below the median A-HIPI risk had a 3-year progression-free survival of 92%, compared with 80% for those above the median. A-HIPI worked similarly in both treatment arms. 

Better risk scores can help patients and their care teams plan follow-up, understand risk, and choose clinical trials when needed. 

Read this abstract: Clinical prognostication in the SWOG 1826 randomized clinical trial of nivolumab-AVD versus brentuximab-AVD: Performance of the advanced-stage Hodgkin lymphoma international prognostic index (A-HIPI) 

Key takeaways

• A small study suggests some people may need less chemotherapy if an early PET scan looks good.
• In a large study, nivolumab plus AVD worked better than brentuximab vedotin plus AVD at 3 years.
• Another large study with 5-year results supports BrECADD over eBEACOPP for adults ages 18–60.
• The chemotherapy combination eBEACOPP had better 5-year progression-free survival than ABVD when used as a first treatment.
• A blood test called ctDNA predicts risk earlier and more clearly than a PET scan.
• A newer risk score (A-HIPI) estimated risk better than the older IPS score.

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