The management of patients with follicular lymphoma is controversial, particularly in those with follicular small cleaved cell (FSCC) or nodular poorly differentiated lymphoma (NPDL). Some advocate no treatment until symptoms arise, while others prefer to treat with intensive combination regimens and others with single agents. We reviewed the long-term effects of two types of combination chemotherapy on relapse-free survival and survival on 91 patients (88 were stages III-IV) who had received no previous chemotherapy. Those patients with FSCC lymphoma obtaining a complete remission had a significantly longer median survival than did those obtaining a partial remission (13 years versus 2 years). An adriamycin-containing regimen appeared to be the key factor in obtaining a complete remission in FSCC after taking into consideration prognostic factors. Not only was the complete response rate significantly higher for patients receiving adriamycin, but so too was the median survival and relapse-free survival. BCG immunotherapy appeared to be important in preventing relapse in some of the complete responders with NPDL who received adriamycin.