Biaxin Based Antibiotic Therapy in Previously Untreated, Advanced Stage Indolent Lymphoma

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