By using the GRADE system, we updated the guidelines for management of follicular cell lymphoma issuedin 2006 from SIE, SIES, and GITMO group. We confirmed our recommendation to frontline chemoimmuno-therapy in patients with Stage III–IV disease and/or high tumor burden. Maintenance rituximab was alsorecommended in responding patients. In patients relapsing after an interval longer than 12 months fromfrontline therapy, we recommended chemoimmunotherapy with non cross-resistant regimens followed byrituximab maintenance. High dose chemotherapy followed by hematopoietic stem cell transplant wasrecommended for young fit patients who achieve a response after salvage chemoimmunotherapy.