The survival and proliferation of follicular lymphoma (FL) cells is strongly dependent on macrophages, their presence being necessary for the propagation of FL cells in vitro. To this regard, as shown also for the majority of solid tumors, a high tissue content of tumor-associated macrophages (TAMs), particularly if showing a pro-tumoral phenotype (also called M2) has strongly associated with a poor outcome among FL patients treated with chemotherapy. The introduction of rituximab, an anti-CD20 antibody which can be used by TAMs to performed antibody-dependent cellular cytotoxicity and antibody-dependent cellular phagocytosis, has challenged this paradigm. In the rituximab-era, in fact, clinical studies have yielded conflicting results in FL, showing variable outcomes based on the type of employed regimen. This has highlighted for the first time that the impact of TAM on the prognosis of FL patients may depend on the administered treatment, emphasizing the need to better understand how currently available therapies affect macrophage function in FL. We summarize here the impact of approved and novel therapies for FL on the biology of TAMs, including radiation therapy, chemotherapy, anti-CD20 monoclonal antibodies, lenalidomide, and targeted agents, and describe their effects on macrophage phagocytosis, polarization and function. While novel agents targeting the CD47/SIRPα axis are being developed and showing promising activity in FL, a deeper understanding of macrophage biology and their complex pathways will help to develop novel and safer therapeutic strategies for patients with this type of lymphoma.