Background: Recent trials demonstrated that treatment results of BEACOPPesc are likely better than ABVD for advanced Hodgkin Lymphoma (HL). However, BEACOPPesc is associated with more toxic effects, with post treatment infertility as one of the major concerns. Aim: The aim of this study was to identify females in generative age with advanced HL who do not require more aggressive approach than ABVD. Patients and methods: This study was performed on 147 females younger than 40 years with advanced HL, diagnosed between 1997 and 2011. The initial treatment was 6-8 cycles of ABVD +/- radiotherapy. Prognostic relevance of IPS, ESR≥50 mm/h, as well presence of B symptoms, bulky disease and extranodal disease (EN) were examined. Results: For the whole group 5-year overall survival (OS) was 81% and 5-year event free survival (EFS) was 66%. Based on examined parameters, in univariate analysis worse OS had patients with IPS≥3 (5-year OS 61.1% vs. 87.3%; log rank, p=0.000) and EN (5-year OS 71.9% vs. 83.5%; log rank, p=0.036). Worse EFS had patients with IPS≥3 (5-year EFS 41.7% vs. 73.9%) and EN (5-year EFS 40.6% vs.73.0%) (log rank; p=0.000, p=0.000, respectively). The multivariate analysis identified IPS≥3 as the independent prognostic factor both for OS (p=0.002) and EFS (p=0.023), as well as EN for EFS (p=0.027). Subsequently, we analyzed the subgroup of 111 patients with low IPS. Thirty patients without bulky disease (27.0% of low IPS patients, 20.4% of the entire group) had better OS (5-year OS 100% vs. 82.7%, log rank, p=0.028) and trend toward better EFS (5-year EFS 90% vs. 67.9%, log rank; p=0.06), with only 2 deaths until the end of follow up. Based on IPS score (0, 1, 2), presence of ESR≥50 mm/h, B symptoms and EN there was no difference both in OS (log rank; p=0.166, p=0.359, p=0.459, p=0.865, respectively) and EFS (log rank; p=0.098, p=0.933, p=0.383, p=0.187, respectively). Moreover, bulky disease in this subgroup retained its prognostic significance in multivariate analysis for OS (p=0.044; RR=4.577; 95% CI 1.042-20.106). Conclusion: ABVD is very effective for females with advanced HL younger than 40 years with low IPS and without bulky disease.