This large study in teenagers and adults with advanced Hodgkin lymphoma showed that adding the immunotherapy drug nivolumab to AVD chemotherapy controls the disease better than the regimen containing brentuximab: after two years, 92% of patients had no relapse. Side effects were fewer, and almost no patient needed radiotherapy, which matters a great deal for young people because of late side effects.
Adults and children aged 12 and over
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| 6 cycles | |||
| Doxorubicin, vinblastine, dacarbazine (AVD) | As per those drugs' labels | IV | Before nivolumab |
| Nivolumab | 240 mg (below 40 kg: 3 mg/kg) | IV, 30-minute infusion | Every 2 weeks (given last) |
G-CSF prophylaxis from cycle 1 is recommended.
Untreated stage III or IV classic Hodgkin lymphoma (age 12 years and older)
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Nivolumab | 240 mg over 30 minutes (12–17 years: 3 mg/kg, maximum 240 mg) | IV | Days 1 and 15 |
| Doxorubicin | 25 mg/m² | IV | Days 1 and 15 |
| Vinblastine | 6 mg/m² | IV | Days 1 and 15 |
| Dacarbazine | 375 mg/m² | IV | Days 1 and 15 |
G-CSF is recommended from Cycle 1; nivolumab should be infused after the AVD drugs. Monitor liver enzymes, creatinine and thyroid function at baseline and periodically for immune-mediated adverse reactions.
Newly diagnosed advanced-stage (stage III–IV) classic Hodgkin lymphoma, age 12 years and older; in the EHA guideline (2026), the preferred approach for patients over 60 years and a less intensive alternative to BrECADD in younger patients (level 1A)
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Nivolumab | Adults: 240 mg; under 18 years: 3 mg/kg (maximum 240 mg) | IV | Days 1 and 15 |
| Doxorubicin | 25 mg/m² | IV | Days 1 and 15 |
| Vinblastine | 6 mg/m² | IV | Days 1 and 15 |
| Dacarbazine | 375 mg/m² | IV | Days 1 and 15 |
Doses from the full text of the S1826 trial. Prophylactic G-CSF was optional with N-AVD and mandatory with BV-AVD; dexrazoxane was permitted to reduce the risk of doxorubicin cardiotoxicity. The cumulative doxorubicin dose over six cycles is 300 mg/m². In the EHA guideline (2026), N-AVD is recommended with PET-guided 30 Gy radiotherapy.
On the page “Lymphoma” · Treatment regimens and dosing: Hodgkin lymphoma
Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.
Six 28-day cycles, IV on days 1 and 15: nivolumab 240 mg in adults (3 mg/kg under 18 years, maximum 240 mg), doxorubicin 25 mg/m², vinblastine 6 mg/m² and dacarbazine 375 mg/m². G-CSF optional.
Six 28-day cycles, IV on days 1 and 15: brentuximab vedotin 1.2 mg/kg (weight capped at 100 kg) with the same AVD doses; G-CSF mandatory.
Source of the regimen details: Full text of the paper in PMC (PMC11488644), Trial Design section; FDA approval status from news reports of March 2026
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Adolescents (aged 12 years and older) and adults with newly diagnosed stage 3 or 4 classic Hodgkin lymphoma.
Primary outcome: progression-free survival (from randomisation to first progression or death from any cause).
Secondary outcomes: event-free survival, overall survival, safety and quality of life.
Immune-related adverse events with nivolumab were uncommon. Brentuximab vedotin was associated with more treatment discontinuation and more peripheral neuropathy. Neutropenia was more frequent with N-AVD (G-CSF was optional in this arm), but rates of febrile neutropenia, sepsis and infection were not increased (full text of the paper).
Based on this study, on 20 March 2026 the FDA approved nivolumab with AVD for first-line treatment of stage 3 or 4 classic Hodgkin lymphoma in patients aged 12 years and older. N-AVD is now one of the preferred first-line options in advanced Hodgkin lymphoma, especially in adolescents and older patients. In Europe, BrECADD (HD21 trial) is the competing option for adults aged 60 years and younger.
The study was open-label and follow-up is still relatively short; overall survival data are immature. G-CSF was used differently in the two arms. The comparator was BV-AVD, and there was no direct comparison with intensified regimens such as BrECADD.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.
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