Fludarabine, Pixantrone and Rituximab vs Fludarabine and Rituximab forRelapsed or Refractory Indolent NHL

Inclusion Criteria

Histologically confirmed relapsed or refractory indolent non-Hodgkin's lymphoma (NHL)
Any stage (Ann Arbor staging, Appendix 15.7), with or without B symptoms
CD 20+ lymphoma (confirmed by immunochemistry)
Measurable disease.
Atleast 1 prior therapy.
Age ≥ 18 years
Life expectancy of at least 3 months
ECOG performance status (PS) of 0 or 1
Adequate cardiac function defined as LVEF ≥ 50% by MUGA scan
Adequate renal function
Adequate hepatic function
Adequate bone marrow function
Recovery from all acute toxicities from prior therapies (except alopecia and grade 1 peripheral neuropathy).

Exclusion Criteria

Prior treatment with a cumulative dose of doxorubicin equivalent exceeding 450 mg/m2
Radiotherapy, chemotherapy or other therapies for NHL within 4 weeks of treatment start
Systemic corticosteroids to treat NHL within 5 days prior to first dose of study treatment.
Radioimmunotherapy (RIT) within 3 months of treatment start
Known hypersensitivity to the excipients or the study drugs that the patient will receive
Known Type I hypersensitivity or anaphylactic reactions to murine proteins or to any component of rituximab
Major thoracic and/or abdominal surgery in the preceding 4 weeks, from which the patient has not fully recovered (patients who have had minor surgery and one week's recovery period may be enrolled)
HIV-related lymphoma
Active CNS involvement
Clinically significant cardiovascular abnormalities
Serious (NCI CTCAE grade 3-4) intercurrent infection at randomization, infection requiring oral antibiotics, or deep-seated or systemic mycotic infections.
Investigational study drug within 30 days before randomization. Patient must have recovered from all side effects of other investigational therapy.
Clinical symptoms suggesting unresolved HIV, HBV or HCV infection. .
History of another malignancy except: curatively treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in remission, or any other cancer from which the patient has been disease-free for 5 years
Pregnant or lactating women
Potentially fertile men and women and their sexual partners not willing to use adequate contraception as defined by the Investigator during the study and for 6 months after the last day of study drug administration