OBJECTIVES: Indolent non-Hodgkin lymphoma (iNHL) is a hematologic malignancy characterized by slow progression. Although response rates to first-line therapy are high, patients often relapse repeatedly. There are no guidelines for the treatment of relapsed/refractory iNHL and the economic impact in Canada is unknown. The objective of this study was to understand treatment patterns, health care resource utilization and cost for the management relapsed/refractory iNHL in Canada. METHODS: A retrospective chart review was conducted in 3 Canadian Oncology centers. Patients included were ≥18 years, diagnosed with follicular lymphoma, small lymphocytic lymphoma, lymphoplasmacytic lymphoma or marginal zone lymphoma, received prior treatment with ≥2 chemotherapy- or immunotherapy-based regimens and were refractory to rituximab and an alkylating agent. Data were collected from iNHL diagnosis until end of study (i.e. death, loss to follow-up or March 31, 2015), with the index date defined as the date at which patients met all eligibility criteria. Mean monthly cost per patient was calculated from index date to end of study. Canadian unit costs were obtained from the literature and government publications. RESULTS: A total of 40 iNHL patients met the eligibility criteria. Of these, 24 (60%) had a diagnosis of follicular lymphoma. The median age at index date was 64 years. With each line of treatment, the proportion of unique regimens administered increased while the number of patients receiving therapy decreased. Furthermore, the median time to relapsed/refractory diagnosis decreased with each subsequent line of treatment. Mean monthly cost per patient was C$5,420 including hospitalizations (43%), treatments (38%), medical procedures (17%) and medical visits (1%). CONCLUSIONS: This study demonstrates that the management of relapsed/refractory iNHL becomes increasingly challenging throughout the course of the disease and generates considerable costs. Patients become less responsive to therapies over time and there is no consistent standard of care for relapsed/refractory iNHL patients.