The full-scale existing treatment plant in a paper mill in Hedera, Israel, includes equalization, solids separation by either straining or by dissolved air flotation and biological treatment by activated sludge. The operation of the existing biological process is often characterized by disturbances, mainly bad settling, voluminous bioflocs, followed by wash-out of the biosolids. This paper summarizes the results obtained in a study based on a pilot plant including a membrane biological reactor (MBR) compared to the "conventional" activated sludge process in the aerobic treatment of the effluent obtained from an anaerobic reactor. During the pilot operation period (about 90 days after achieving steady state) the MBR system provided steady operation performance, while the activated sludge produced effluent characterized by oscillatory values. The results are based on average values and indicate much lower levels of suspended solids in the MBR effluent, 2.5 mg/L, as compared to 37 mg/L in the activated sludge. As a result, the total organic mater content was also substantially lower in the MBR effluent, 129 vs 204 mg/L as COD, and 7.1 vs 83 mg/L as BOD. The MBR enabled better nitrification. The ability to develop and maintain a concentration of over 11,000 mg/L of mixed liquor volatile suspended solids in the MBR bioreactor enabled an intensive bioprocess at relatively high cell residence time. As a result the biosolids which had to be removed as excess sludge were characterized by relatively low volatile/total suspended solids ratio, around 0.78. This could facilitate and lower the cost of biosolids treatment and handling. The results of this comparative study indicate that in the case of MBR there will be no need for further treatment, while after activated sludge additional filtration will be required. The study leads to the conclusion that MBR will be the best technology for aerobic treatment of the anaerobic effluent of the paper mill.