BRIEF Bendamustine and Rituximab In Elderly Follicular

Inclusion Criteria:

* Histologically confirmed follicular lymphoma CD20+, all grades except the grade 3b with a lymph node biopsy performed within 6 months before study entry and with material available for central review
* A minimal initial immunology is required, including : CD20, bcl-2, CD10 and CD5
* Age must be ≥ 60 years
* Patients not previously treated
* Patients with an intermediate or high risk FLIPI score requiring 2 or more of the following adverse prognostic factors:

  1. Age \>60 ans
  2. Ann Arbor Stage (III-IV vs. I-II)
  3. Hemoglobin level ( \< 12g/dL vs. ≥ 12 g/dL)
  4. Number of nodal areas (\< 5 vs. ≥ 5) (Note: LDH should not be considered as an adverse prognostic factor in this study since it is considered as high tumor burden in the GELF criteria)
* Low burden disease at study entry according to the GELF criteria
* Patients with at least one measurable site of disease: patients with only blood or marrow or splenic infiltration are excluded
* Performance status ≤ 2 on the ECOG scale
* Adequate hematological function (unless abnormalities are related to lymphoma infiltration of the bone marrow) including:
* Hemoglobin ≥ 8.0 g/dL (5.0 mmol/L)
* Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
* Platelet count ≥ 100 x 109/L
* Adequate renal function: calculated creatinine clearance \> 50 ml/min (according to MDRD method) unless these abnormalities are related to lymphoma
* Adequate hepatic function: Total bilirubin \< 2.0 mg/dl (34 µmol/L), AST (SGOT) and ALT (SGPT) ≤ 2.5 x the upper limit of normal unless these abnormalities are related to lymphoma
* Adequate cardiac function: LEVF ≥ 50% calculated by echocardiography or scintigraphy
* Having previously signed a written informed consent

Exclusion Criteria:

* Other histological types of lymphoma than follicular lymphoma
* Grade 3b follicular lymphoma
* Patients previously on watch and wait since more than 6 months from diagnosis
* Patients previously treated for lymphoma, except splenectomy
* Patients with low FLIPI score (0 or 1 adverse prognostic factors not considering elevated LDH)
* Bulky disease at study entry according to the GELF criteria
* Presence or history of CNS disease (either CNS lymphoma or lymphomatous meningitis)
* Patients with prior or concomitant malignancies except non-melanoma skin cancer or adequately treated in situ cervical cancer or previous cancer in CR without any treatment in the last 5 years
* Positive HIV, HBV (anti-HBc positivity) and HCV serologies before inclusion
* Poor Performance status \> 2 on the ECOG scale
* Known contra-indication to study product
* 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).
* Any other co-existing medical or psychological condition that will preclude participation in the study or compromise ability to give informed consent.