Follicular Lymphoma / Marginal Zone Lymphomas (Non-Hodgkin Lymphoma)

Regimen Options

Last Updated: 07/01/2026 See Details

NOTE: FOR RITUXIMAB, THE USE OF A BIOSIMILAR OR THE REFERENCE PRODUCT IS ON PATHWAY

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
Primary or Initial Therapy	R-CVP (rituximab, cyclophosphamide, vincristine, prednisone)	Low	Moderate	NCCN Guidelines® for B-Cell Lymphomas V.4.2017. Marcus R, et al. Blood. 2005;105(4):1417-23. Hochster H, et al. J Clin Oncol. 2009;27(10):1607-14.
	R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone)	Intermediate	High	NCCN Guidelines® for B-Cell Lymphomas V.4.2017. Czuczman MS, et al. J Clin Oncol. 1999;17(1):268-76. Hiddemann W, et al. Blood. 2005;106(12):3725-32.
	bendamustine and rituximab (BR)	Intermediate	Moderate	NCCN Guidelines® for B-Cell Lymphomas V.4.2017. Verriere B, et al. Hematol Oncol. 2017:abstr. Rummel MJ, et al. J Clin Oncol. 2005;23(15):3383-9. Rummel MJ, et al. Blood. 2009;114(22):abstr405.
	rituximab	Low	Low	NCCN Guidelines® for B-Cell Lymphomas V.4.2017. Journal of Clinical Oncology 20, no. 20 (October 15 2002) 4261-4267.
Maintenance (Consolidation or extended dosing)	rituximab maintenance up to 2 years	Low	Low	NCCN Guidelines® for B-Cell Lymphomas V.4.2017. Salles G, et al. Lancet. 2011;377(9759):42-51. Van Oers MHL, et al. J Clin Oncol. 2010;28(17):2853-8.
Subsequent Therapy	rituximab	Low	Low	NCCN Guidelines® for B-Cell Lymphomas V.4.2017. Hainsworth JD, et al. J Clin Oncol. 2002;20(20):4261-7. Colombat P, et al. Blood. 2001;97(1):101-6. McLaughlin P, et al. J Clin Oncol. 1998;16(8):2825-33.
	R-CVP (cyclophosphamide, vincristine, prednisone)	Low	Moderate	NCCN Guidelines® for B-Cell Lymphomas V.4.2017. Marcus R, et al. Blood. 2005;105(4):1417-23. Hochster H, et al. J Clin Oncol. 2009;27(10):1607-14.
	R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone)	Intermediate	High	NCCN Guidelines® for B-Cell Lymphomas V.4.2017. Czuczman MS, et al. J Clin Oncol. 1999;17(1):268-76. Hiddemann W, et al. Blood. 2005;106(12):3725-32.
	bendamustine and rituximab (BR)	Intermediate	Moderate	NCCN Guidelines® for B-Cell Lymphomas V.4.2017. Verriere B, et al. Hematol Oncol. 2017:abstr. Rummel MJ, et al. J Clin Oncol. 2005;23(15):3383-9. Rummel MJ, et al. Blood. 2009;114(22):abstr405.
CAR T-cell Therapy: 3rd line or later	axicabtagene ciloleucel (Yescarta)	High	Low	NCCN Guidelines® for B-Cell Lymphomas V.4.2026 Neelapu, SS et al. J Clin Oncol 43, 3573-3577
	lisocabtagene maraleucel (Breyanzi)	Low	Low	NCCN Guidelines® for B-Cell Lymphomas V.4.2026 Palomba, L et al. DOI: 10.1016/S0140-6736(25)02435-3
	tisagenlecleucel (Kymriah) for follicular lymphoma	High	Low	NCCN Guidelines® for B-Cell Lymphomas V.4.2026 Schuster, SJ et al. DOI: 10.1016/j.jtct.2025.12.077
BiTE (bispecific antibodies) Therapy: 3rd line or later	mosunetuzumab-axgb (Lunsumio) for follicular lymphoma	Low	Low	NCCN Guidelines® for B-Cell Lymphomas V.4.2026 Sehn, LH et al. Blood (2025) 145 (7): 708–719
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	Best Supportive Care or Clinical Trial

Primary or Initial Therapy

Evolent Pathways

R-CVP (rituximab, cyclophosphamide, vincristine, prednisone)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

bendamustine and rituximab (BR)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

rituximab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Maintenance (Consolidation or extended dosing)

Evolent Pathways

rituximab *maintenance up to 2 years*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Subsequent Therapy

Evolent Pathways

rituximab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

R-CVP (cyclophosphamide, vincristine, prednisone)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

bendamustine and rituximab (BR)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

CAR T-cell Therapy: 3rd line or later

Evolent Pathways

axicabtagene ciloleucel (Yescarta)

Febrile Neutropenic Risk

high

Emetogenic Risk

low

References

Evolent Pathways

lisocabtagene maraleucel (Breyanzi)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tisagenlecleucel (Kymriah) *for follicular lymphoma*

Febrile Neutropenic Risk

high

Emetogenic Risk

low

References

BiTE (bispecific antibodies) Therapy: 3rd line or later

Evolent Pathways

mosunetuzumab-axgb (Lunsumio) *for follicular lymphoma*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

	Regimen	Alternative	References
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
Initial therapy	lenalidomide and rituximab applies to marginal zone lymphoma	Alternative: (CVP + R) cyclophosphamide + vincristine + prednisone + rituximab

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Initial therapy

Regimen

** lenalidomide and rituximab ** applies to marginal zone lymphoma

Pathways and Low-Value Regimens

Follicular Lymphoma / Marginal Zone Lymphomas (Non-Hodgkin Lymphoma)