Previously untreated stage III or IV mantle cell lymphoma

Treatment Phase: Induction treatment

Clinical criteria:

• The condition must be CD20 positive,

AND

• The treatment must be in combination with rituximab,

AND

• The condition must be previously untreated,

AND

• The condition must be symptomatic,

AND

• The treatment must be for induction treatment purposes only,

AND

• Patient must not receive more than 6 cycles (12 doses) of treatment under this restriction,

AND

• Patient must not be eligible for stem cell transplantation.

Previously untreated stage II bulky or stage III or IV indolent non-Hodgkin's lymphoma

Treatment Phase: Induction treatment

Clinical criteria:

• The condition must be CD20 positive,

AND

• The condition must be previously untreated,

AND

• The condition must be symptomatic,

AND

• The treatment must be for induction treatment purposes only,

AND

• The treatment must be in combination with rituximab or obinutuzumab,

AND

• The treatment must not exceed 6 cycles (12 doses) with this drug under this restriction.

Follicular lymphoma

Treatment Phase: Re-induction treatment

Clinical criteria:

• The condition must be CD20 positive,

AND

• The condition must be refractory to treatment with rituximab for this condition,

AND

• The condition must be symptomatic,

AND

• The treatment must be for re-induction treatment purposes only,

AND

• The treatment must be in combination with obinutuzumab,

AND

• The treatment must not exceed 6 cycles (12 doses) with this drug under this restriction.

The condition is considered rituximab-refractory if the patient experiences less than a partial response or progression of disease within 6 months after completion of a prior rituximab-containing regimen.