Previously Untreated follicular lymphoma or non-follicular lymphoma will be recrited at MSKCC

Inclusion Criteria:

• Histologically confirmed diagnosis of follicular lymphoma: grades I, II, or IIIA, or non-follicular lymphoma: lymphoplasmacytoid lymphoma, small lymphocytic lymphoma, marginal B-cell lymphoma, or MALT lymphoma (as defined in the WHO classification1) as reviewed by a hematopathologist at Memorial Hospital.

• Staging fulfills criteria for no initial treatment according to GELF criteria for advanced stage disease. None of the following should be present:

  • A nodal or extranodal mass with a diameter of >7 cm,
  • Involvement of at least three nodal sites [each with a diameter of >3 cm],
  • Systemic symptoms,
  • Symptomatic splenomegaly,
  • Ureteral compression.
  • No prior treatment for lymphoma is permitted.
  • Measurable disease is required.
  • Karnofsky performance status > 70%
  • The patient may not have a previous history of radiation therapy.
  • Patient or guardian must be able to sign voluntary written consent.
  • Male or female patients 18 years of age or greater.

Exclusion Criteria:

• Allergy to biaxin (clarithromycin), erythromycin, or other macrolide antibiotic. Patients requiring use of ergot derivatives, pimozide, cisapride, or astemizole; combination with ranitidine bismuth citrate should not be used in patients with history of acute porphyria or CrCl <25 mL/minute.
• Prior treatment with Biaxin (clarithromycin) during the prior 6 months.
• Histologic diagnosis of follicular grade 3B or aggressive non-Hodgkin's lymphoma.
• Histologic evidence of transformation from low grade/indolent NHL to aggressive NHL.
• Prior treatment for non-Hodgkin's lymphoma.
• Regional lymphoma (peripheral stages I and II) eligible for involved field irradiation.

• GELF criteria21 for institution of systemic chemotherapy, which includes:

  • A nodal or extranodal mass with a diameter of >7 cm,
  • Involvement of at least three nodal sites [each with a diameter of >3 cm],
  • Systemic symptoms,
  • Symptomatic splenomegaly,
  • Ureteral compression.
• Patients with a known history of HIV, Hepatitis B or C seropositivity.
• Patients who require therapy with systemic corticosteroids.
• Prior history of malignancy within the past five years or a concurrent malignancy, with the exceptions of cutaneous basal cell carcinoma or carcinoma in situ of the uterine cervix.
• Pregnant or lactating women, since imaging cannot be done in this setting.18