Inclusion Criteria:

- Patients older than 18 years of age

- Follicular lymphoma, newly diagnosed or previously treated but no more than 2
previous regimens

- Relapse of disease must be greater than 6 months after last chemotherapy

- Stages II, III or IV

- Eastern Cooperative Group (ECOG) performance status of 0 or 1. If ECOG 2-4, poor
performance must by due to lymphoma as judged by study investigator.

- Patient signed written informed consent

- Adequate renal function defined as a glomerular filtration rate (GFR) > 60 ml/min

- Adequate blood counts (absolute neutrophil count ≥ 1,500, platelets ≥100,000), unless
low due to lymphomatous involvement of the bone marrow.

- No known allergies to the chemotherapeutic agents

- No other major disabling co morbidities

- Adequate pulmonary function, defined as corrected DLCO greater than 70% of predicted
and FEV1 (forced expiratory volume in one second, a test of respiratory function)
greater than 50% of predicted.

- Adequate hepatic function as assessed by study investigator

- Adequate cardiac function, defined as baseline MUGA (Multiple gated acquisition, a
test of heart function) >50%

Exclusion Criteria:

- Stage I follicular lymphoma

- ECOG performance status ≥ 2, unless due to lymphoma

- Patient refuses to sign written informed consent

- Poor renal function defined as GFR <60ml/min

- Abnormal liver function as assessed by study investigator

- Poor bone marrow reserve (absolute neutrophil count <1,500 and/or platelets <
100,000) not attributable to lymphomatous involvement of the bone marrow.

- Hypersensitivity to the chemotherapeutic agents

- Major disabling co morbidities like uncontrolled severe HTN (hypertension), active
coronary artery disease, liver cirrhosis.

- Previously diagnosed malignancy other than basal or squamous cell carcinoma of the
skin diagnosed <5 years prior.

- Central nervous system disease

- History of advanced cardiac disease (Active angina, Congestive heart failure with a
LVEF (left ventricular ejection fraction) <50%).