Phase II Trial of Response-Adapted Therapy Based on Positron Emission Tomography (PET) for Bulky Stage I and II classical Hodgkin Lymphoma (HL)

Histologically proven classical Hodgkin lymphoma. Nodular lymphocyte predominant Hodgkin lymphoma is excluded. Patients must have clinical Stage IA, IB, IIA or IIB disease. Patients with E extensions will be eligible if all other criteria have been met. Patients must have a mediastinal mass > 0.33 maximum intrathoracic diameter on standing postero-anterior chest x-ray or measuring > 10 cm in its largest diameter on axial CT images Bone marrow biopsy is required. No currently active second malignancy other than non-melanoma skin cancers. Patients are not considered to have a currently active malignancy if they have completed therapy and are considered by their physician to be at less than 30% risk of relapse.No prior treatment (chemotherapy or radiation therapy) for Hodgkin lymphoma. ECOG Performance status 0-2. LVEF by ECHO or MUGA within institutional normal limits unless thought to be disease related. DLCO > 60% with no symptomatic pulmonary disease unless thought to be disease related. Patients with a history of intravenous drug abuse, or any behavior associated with an increased risk of HIV infection, should be tested for exposure to the HIV virus, and an HIV test is required for entry on this protocol, within 16 days prior to registration. HIV positive patients are eligible if they have CD4 counts < 400/mcL and are on concurrent antiretrovirals. Patient HIV status must be known prior to registration. HIV-positive patients must not have multi-drug resistant HIV infections; CD4 counts < 400/mcL or other concurrent AIDS-defining conditions. Initial Required Laboratory Data: Hgb >/= 10 g/dL, ANC >/= 1000/L, Platelet count >/= 100,000/L, Serum Creatinine </= 2 mg/dL, Direct Bilirubin </= 2 mg/dL, AST/ALT </= 2 x upper limit of normal. Age >/= 18 years.