**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Tarek Ashour, Cleveland Clinic, Cleveland, OH

**Main Body of the Abstract**
76-year-old male patient with history of IgM lambda Waldenstrom macroglobulinemia (WM) and Large granular lymphocytic leukemia (LGL). He received multiple treatments for WM over 8 years. He achieved a partial remission and was kept under observation. He developed cytopenias secondary to LGL clone and was treated for that, ultimately becoming transfusion dependent. Due to worsening fatigue and recurrent ascites associated with elevated liver enzymes and worsening kidney function, he was admitted for further management. His baseline creatinine was 1.2 mg/dl, he presented 3 months later with creatinine of 1.74 mg/dl, urinalysis was bland and urine protein creatinine ratio was 0.43.  Serum IgM 490 mg/dl, Serum lambda light chain 268 mg/l and serum Kappa light chain 14.3 mg/l. Kidney ultrasound showed no hydronephrosis. A kidney biopsy showed light chain (AL) amyloidosis involving glomeruli, vessels and tubulointerstitium. ECHO findings and elevated NT-Pro BNP were suggestive of cardiac amyloidosis. Given the expected findings of lymphoplasmacytic clone on prior bone marrow evaluation, he was started on Rituximab. His clinical picture and kidney function continued to worsen, and he was placed on hospice care.
WM and AL amyloidosis are rare disorders which uncommonly present concurrently. Treatment of AL amyloidosis in WM targets the lymphoplasmacytic clone identified on bone marrow biopsy and differs from plasma cell directed treatment such as daratumumab. Diagnosis needs high index of suspicion especially when the patient has mild proteinuria like our patient. Outcome is usually worse compared to non-IgM AL amyloidosis . Early detection might improve survival and preserve organ function.



Renal AL amyloidosis: an unusual presentation PA62 (#255)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.