hello there! 4 months of remission followed by recurrence shows you were not compliant with cytoxan and steroids and rituxan. Did u take all 4 doses weekly for a month of rituximab? what ever past is past now that you have been started on these three meds i recommend to take them as prescribed and chances are your disease will go back to remission 90- 95 %. it would have been better if you would have stated the stage of the disease whether it is Localized, early symptomatic, generalised, or severe, or refractory. we call the disease severe when the creatinine levels rise more than 5.6 and genralised when a vital organ like kidney etc are involved. . minimize your exposure to ill contacts as you are immunosuppressed. and your prednisone issue yes you can replace it with methy prednisone IV 0.5 mg /kg/day . there are some other treatment addition too for the comorbidities like deadly pneumocystis pneumonia a complication of immunosuppression. for that Trimethoprim-sulfamethoxazole thrice a day to be used for at lest six months after last dose of rituximab. And Plasma exchange is also used it the disease is severe that is creat level 5.6 and disease is deterioriating. ANd METHOTREXATE can also be used if the disease is localized or less severe 20-25 mg per week but it takes longer to reach remission with it. IVIGs intravenous immunoglobulins, mycophenolate mofetils (2g/day) , etanercept, infliximab, 15-de oxyspergualin , antithrombocyte globulins, alemtuzumabs, abatacepts and stem cell transplants are some other treatment option but costly . let sumarise To induce remission you need cyclophosphamide rituximab Pneumocystic TMP-SMZ prophylaxis glucocorticoids methotrexate (if local) To mantain remission you will need Azathioprine methotrexate leflunamide glucocorticoids I wish you good luck and get well soon. regards Dr Shafi ullah khan My Patient is my family