The ABVD regimen is the standard of care for patients with Hodgkin lymphoma up to 70 years. This regimen has been considered to be too toxic for elderly patients, and alternative regimens have been proposed, that are often associated with a reduced efficacy. The evaluation of comorbidity has not been extensively studied in HL. We reasoned that evaluation of comorbidity according to a standardized approach, the Cumulative Illness Scaling Rate (CIRS) might be a predictor for overall survival (OS). We studied 62 consecutive elderly patients with HL (median age 68 years, range 60-83 years), who had been treated in our institution between 1999 and 2016. Chemotherapy was ABVD in 47 (76%) patients, COPP in 12 (19%) patients, and other in 3 (5%) patients. OS at 2 years was 70% (95% C.I., 55-81%). Comorbidity was rated on the 4-point CIRS scale for 13 main organ systems. 36 patients had no severe comorbidity (score >3) and were considered fit (58%), while 26 patients had at least one severe comorbidity and were considered frail (42%). Patients with at least one severe comorbidity were more likely to be >70 years old (p=0.03), to have advanced stage disease (p=0.02) and not to receive ABVD (p=0.01). Patients with at least one severe comorbidity had a 2-year OS of 17% (95% C.I. 3-41%) versus 89% (95% C.I., 73-96%) in fit patients (p=0.001). We next restricted the analysis to ABVD-treated patients. Frail patients still had a significant worse 2-year OS (65%; 95% C.I., 25%-88%) with respect to fit patients (97%; 95% C.I., 79-99%) (p=0.02), that was however better than for patients treated with MOPP (2-year OS: 11%). We conclude that a significant proportion of elderly HL patients has severe comorbidity on the CIRS scale, that impacts on prognosis. Prospective studies including comprehensive geriatric assessment are warranted to better tailor therapy in the often frail elderly patients with HL.