Inclusion Criteria:

- Histologically confirmed follicular lymphoma (grade 1,2, and 3a with material
available for central review)

- Ann Arbor stage II-IV

- Aged 60 years or over, or aged less than 60 but anthracycline-based therapy
contra-indicated

- No prior systemic therapy (one episode of prior local radiotherapy is allowed)

- At least one of the following criteria for initiation of treatment:

- Rapid generalized disease progression in the preceding 3 months

- Life threatening organ involvement

- Renal or macroscopic liver infiltration

- Bone lesions

- Presence of systemic symptoms or pruritus

- Haemoglobin < 10 g/dL or WBC < 3.0 × 109/L or platelet counts < 100 × 109/L due to
marrow involvement

- Adequate haematological function (unless abnormalities are related to lymphoma
infiltration of the bone marrow):

- Haemoglobin ≥ 8.0 g/dL

- Absolute neutrophil count (ANC) ≥ 1.5 x 109/L

- Platelet count ≥ 100 x 109/L

- Written Informed Consent

Exclusion Criteria:

- Overt transformation to diffuse large B-cell lymphoma

- Grade 3b follicular lymphoma

- Presence or history of CNS disease (either CNS lymphoma or lymphomatous meningitis)

- WHO performance status 3 or 4

- Impaired renal function defined as estimated Glomerular filtration rate (eGFR) < 30
mL/min using the Modification of Diet in Renal Disease (MDRD) formula

- Impaired hepatic function defined as serum bilirubin more than twice upper limit of
normal (unless due to lymphoma or Gilbert's syndrome)

- Life expectancy less than 12 months

- Pre-existing neuropathy

- Active auto-immune haemolytic anaemia

- Serological evidence of infection with HIV, hepatitis B (positivity for surface
antigen or core antibody) or hepatitis C

- Allergy to murine proteins

- Corticosteroid treatment during the last 4 weeks, unless administered at a dose
equivalent to no more than prednisolone 20mg/day continuously or a single course of
prednisolone 1 mg/kg for up to 7 days

- Concomitant malignancies except adequately treated localised non-melanoma skin cancer
or adequately treated in situ cervical cancer, or cancers that have been in remission
for at least 5 years following surgery with curative intent.

- Major surgery (excluding lymph node biopsy) within 28 days prior to randomisation

- Serious underlying medical conditions, which could impair the ability of the patient
to participate in the trial (e.g. ongoing infection, uncontrolled diabetes mellitus,
gastric ulcers, active autoimmune disease)

- Treatment within a clinical trial within 30 days prior to trial entry

- Any other co-existing medical or psychological condition that will preclude
participation in the study or compromise ability to give informed consent

- Adult patient under tutelage (not competent to sign informed consent)

- Pregnant or lactating women

- All men or women of reproductive potential, unless using at least two contraceptive
precautions, one of which must be a condom