50 year old male with unclear B cell lymphoma, watched for 3-4 years. When presented to care, had diffuse low volume adenopathy. Biopsy with molecular diagnostics was repeated, which showed Waldenstrom Macroglobulinemia (WM) based on a NMYD88 mutation. Patient was observed for 3-4 months with increasing peripheral edema. Patient was restaged and found minimal FDG avid nodes in systemic nodes, bone marrow with WM. Patient was started on RBendamustine (other options were ibrutinib vs others). Patient had incomplete response to RBenda. Renal biopsy was performed because of hypoalbumineia and renal amyloid was identified.

How would you have managed this patient and his treatment regimen(s)? What would you recommend as next steps?