Introduction: The combination of radio and chemotherapy in HL has led to the greatest advances in disease response. The benefit in terms of overall survival (OS) has been jeopardized by long term toxicity related to second malignancies and cardiovascular events. Aim: Analyze the risk factors associated with survival and asses the frequency of secondary malignancies with an ABVD based regimen that restricted radiotherapy only to bulky disease. Materials and methods: We retrospectively analyzed HL patients diagnosed in 4 centers in Tarragona area (Catalonia, Spain), between 1995 and 2015 treated uniformly according to a local protocol. Patients were assigned into 4 groups: G1: favorable early stage: ABVDx6 cycles, G2: Bulky early stage without other risk factors: ABVDx6 + IFRDT. G3: unfavorable early stage (B symptoms) and advanced stage without bulky disease: ABVDx8, G4: Bulky advanced stage: AVBDx8 + IFRDT Results: A total of 183 patients were analyzed with a median follow up of 82 months [range 1-244]. Male/female ratio was 1,29. Median age was 36 years [range 16-82]. Complete response was achieved in 160 patients (87,4%). The estimated OS at 20 years for the whole group was 62.7%. In univariate analysis, worse OS was found in patients with increased LDH, non-NS subtype, albumin <3,5 g/d, B symptoms, HIV+, advance stage and ESR >50 mm (log rank p=0,012; p=0,049; p=0,024; p=0,002; p=0,005; p=0,004 and p=0,001 respectively). The multivariate Cox regression analysis identified B symptoms and ESR >50 mm as independent prognostic factors for OS (p=0,002; p=0,006 respectively). Furthermore, B symptoms was also found as an independent prognostic factor for OS when patients were analyzed according to disease stage (localized and advanced) (p=0,018; p=0,014) while ESR >50 mm was an independent prognostic factor for the advanced disease group only (p=0,038) Secondary malignancies were observed in 18 patients (9,8%). The most frequent were hematological in 6 patients (3 myelodysplastic syndrome, 3 non Hodgkin lymphoma), gynecological 4 patients (2 breast cancer, 2 adnexal carcinoma) and colorectal 2 patients. Two patients developed 2 malignancies. Conclusion: Our risk adapted protocol showed a good rate of response and overall survival with low rate of secondary malignancies. B symptoms and elevated ESR were independently associated with OS in the whole group.