A Study of BV-AVD in People With Bulky Hodgkin Lymphoma

Inclusion criteria

• Histological diagnosis of classical, CD30-positive Hodgkin lymphoma confirmed at enrolling institution.
• Ann Arbor stage I or II FDG-avid disease by FDG-PET/CT.
• Disease bulk defined as any lymph node mass with transverse maximal diameter ≥ 7.0 cm or coronal maximal diameter ≥ 7.0 cm on CT imaging.
• Age 18 and over.
• ECOG Performance Status ≤ 2
• Females of childbearing age must be on an acceptable form of birth control per institutional standards during the treatment period.
• Males must consistently use an acceptable form of contraception per institutional standards during the treatment period.

Exclusion criteria

• Prior systemic therapy or radiation therapy for Hodgkin lymphoma (excluding corticosteroids)
• Cardiac ejection fraction < 50% as measured by echocardiogram.
• Platelet count ≤ 75,000/µL.
• Hemoglobin level ≤ 7.0 mg/dL.
• Absolute neutrophil count ≤ 1.0 K/µL.
• Serum creatinine clearance < 30 mL/minute as estimated by the Cockcroft-Gault Method.
• Transaminase levels > 3 times the upper limit of normal in the absence of a history of Gilbert's disease or hepatic involvement. In patients with Gilbert's disease, > 5 times the upper limit of normal is exclusionary.
• Total bilirubin ≥ 1.5 the upper limit of normal in the absence of a history of Gilbert's disease or hepatic involvement. In patients with Gilbert's disease, > 3 times the upper limit of normal is exclusionary.
• Pre-existing peripheral neuropathy ≥ grade 2 prior to participation.
• Known pregnancy or breast-feeding
• Active viral infection with hepatitis B or hepatitis C. For hepatitis B, patients who are seropositive (hepatitis B core Ab positive) are permitted if HBV DNA is negative by PCR. For hepatitis C, patients who are seropositive (hepatits C Ab positive) are eligible if HCV DNA is negative by PCR and curative therapy has been completed.
• Concurrent malignancy requiring active therapy within the last 2 years with the exception of basal cell or squamous cell carcinoma limited to the skin, carcinoma in situ of the cervix, breast or localized prostate cancer. Adjuvant hormonal therapy for cancer previously treated for curative intent is permitted.
• Patients with autoimmune conditions requiring active, ongoing systemic immunosuppressive therapy.
• Medical illness unrelated to Hodgkin lymphoma which in the opinion of the treating physician and/or principal investigator makes participation inappropriate.

Note: Patients with HIV infection are permitted to enroll but are required to be on antiretroviral regimens that are in accordance with the current International AIDS Society guidelines concurrently with chemotherapy. Use of experimental antiretroviral agents or those containing zidovudine or ritonavir, cobicistat or similar potent CYP3 inhibitors are prohibited. In order to be eligible, patients taking zidovudine or ritonavir, or cobicistat or other CYP3 inhibitors must change to a different regimen 7 days prior to therapy initiation. Subjects must be on HAART for at least 12 weeks prior to therapy.

Note: Patients with pre-existing autoimmune conditions are NOT excluded unless there is an autoimmune condition requiring active, ongoing systemic immunosuppressive therapy. However, careful consideration should be given to patients with pre-existing autoimmune conditions who may need pembrolizumab. Any concerns regarding patients with pre-existing autoimmune conditions and eligibility should be reviewed with the study PI.