Treatment algorithm for newly diagnosed, advanced-stage older Hodgkin lymphoma (HL) patients. All patients should undergo a geriatric assessment to determine fitness before initiation of treatment, which should include at least an evaluation of ADLs, comorbidities, and calculation of noncancer expected survival (https://eprognosis.ucsf.edu/leeschonberg.php). The associated table of geriatric risk categories is adapted from Tucci et al. (with permission).²⁹  Scoring for ADL and IADL indicate number of residual functions. There should also be consideration of pre-phase therapy before initiation of definitive therapy, especially in unfit or frail and/or symptomatic patients with high tumor burden. Furthermore, patient fitness should be reassessed following pre-phase therapy. Aggressive supportive care measures should be pursued, including increased office evaluations (eg, weekly fluid assessments) and intentional comanagement with other disease specialists. Treatment options are based on published data and investigator experience (listed by order of preference); a clinical trial should always be considered. Treatment for unfit and frail patients is highly individualized. Anthracyclines may be considered for unfit patients with minor fitness limitations and preserved cardiac function; dose-attenuated anthracyclines may be considered for select fit patients ages ≥80 years or highly select frail patients ages <80 years with close monitoring of cardiac function (eg, comanagement with cardiology with assessment of ejection fraction q 2 cycles, etc). ADL, activities of daily living; AVD, doxorubicin, vinblastine, dacarbazine; BV, brentuximab vedotion; CCI, Charlson Comorbidity Index; ChIVPP, chlorambucil, vinblastine, procarbazine, prednisone; CIRS-G, Cumulative Illness Rating Scale-Geriatric; IADL, instrumental activities of daily living; PCP, primary care provider; PVAG, prednisone, vinblastine, doxorubicin, and gemcitabine. Scoring for ADL and IADL indicates the number of residual functions.