Amyloidosis Fellowship

What Is an Amyloidosis Fellowship?

Amyloidosis is a disease category defined by the pathological deposition of misfolded proteins as amyloid fibrils in tissues. The clinical spectrum spans light-chain amyloidosis (AL), hereditary and wild-type transthyretin amyloidosis (ATTRv and ATTRwt), AA amyloidosis, and rarer subtypes. Each type carries distinct pathophysiology, diagnostic requirements, and rapidly evolving treatment paradigms—making amyloidosis a genuinely distinct subspecialty domain rather than a simple extension of general hematology or cardiology practice.

Dedicated amyloidosis training programs exist to produce physicians capable of leading comprehensive amyloidosis centers: managing the full diagnostic workup, directing multidisciplinary care teams, and contributing to translational research at a field that is currently experiencing substantial therapeutic development. These are advanced training positions pursued after the completion of an ACGME-accredited subspecialty fellowship.

Because the patient population is concentrated at a small number of high-volume academic centers, meaningful amyloidosis exposure during general subspecialty fellowship is the exception rather than the rule. Trainees who want to work in this space at an academic or referral-center level should plan for a dedicated additional year.

Accreditation Status

Amyloidosis fellowship does not exist as a standalone ACGME-accredited subspecialty. The ACGME does not recognize amyloidosis as an independent program type, and no ACGME program requirements document governs these positions as a distinct category.

Training occurs through one of two structural mechanisms:

• Embedded concentration within an ACGME-accredited fellowship: A trainee completes an ACGME-accredited hematology/oncology or cardiovascular disease fellowship that includes a formal or de facto concentration in amyloidosis, typically at a center with an integrated amyloidosis program. The fellowship itself carries ACGME accreditation; the amyloidosis emphasis does not add or alter that status.
• Stand-alone institutional advanced fellowship (non-ACGME): Several dedicated amyloidosis centers offer post-fellowship training positions that are institutional appointments, not ACGME-accredited programs. These positions are governed entirely by the sponsoring institution. Salary protections, duty-hour rules, and grievance procedures that apply to ACGME-accredited programs do not automatically extend to these appointments.

This distinction is not administrative trivia. It affects your contract terms, your appeal rights if something goes wrong, and how you represent the training on your CV. Read the offer document carefully before accepting any non-ACGME position, and confirm what institutional protections are explicitly in writing.

Types of Amyloidosis Training Pathways

Pathway 1: Embedded Concentration Within ACGME Hematology/Oncology Fellowship

The most common pathway for AL amyloidosis specialists. Trainees match into an ACGME-accredited hematology/oncology fellowship at an institution with a high-volume amyloidosis center—typically one with dedicated clinics, a specialized multidisciplinary team, and active research programs. Clinical exposure to amyloidosis patients is structured into the rotation schedule, and research projects in AL amyloidosis are available. The trainee completes standard hematology/oncology board requirements alongside this concentration.

This pathway is practical if the host institution has genuine volume. At centers without dedicated amyloidosis programs, a "concentration" may amount to opportunistic case exposure rather than structured training.

Pathway 2: Embedded Concentration Within ACGME Cardiovascular Disease Fellowship

Relevant primarily for ATTR cardiomyopathy, which has become a major focus since the approval of tafamidis and the expansion of ATTR recognition in heart failure populations. Cardiology trainees at centers with dedicated cardiac amyloidosis clinics can develop substantial expertise in imaging diagnosis (technetium pyrophosphate scanning, strain echocardiography), genetic workup, and management of ATTR and AL cardiac involvement.

Advanced imaging fellowships (cardiac MRI, nuclear cardiology) at amyloidosis centers can deepen this concentration further, though they are not required.

Pathway 3: Stand-Alone Institutional Advanced Fellowship (Non-ACGME)

Dedicated amyloidosis centers—most prominently Boston University, Mayo Clinic, and Indiana University in the US—offer one- to two-year advanced fellowship positions for physicians who have already completed an ACGME-accredited subspecialty fellowship. These positions are structured around high clinical volume, multidisciplinary team participation, and research productivity. They are not ACGME-accredited, and they are competitive.

This pathway produces the most focused amyloidosis training available. It is the standard preparation for faculty positions at amyloidosis referral centers and for roles as principal investigators on amyloidosis-specific trials.

Prerequisites and Who Should Apply

Prerequisite Training

All dedicated amyloidosis advanced fellowship positions require prior completion of an ACGME-accredited subspecialty fellowship. Accepted feeder fellowships vary by program and amyloidosis type focus:

• Hematology/oncology or hematology alone — primary prerequisite for AL amyloidosis and multisystem programs
• Cardiovascular disease — primary prerequisite for cardiac amyloidosis–focused positions
• Nephrology — relevant for programs with heavy renal amyloidosis focus
• Neurology — relevant for programs emphasizing ATTRv neuropathy and peripheral nervous system manifestations

Board certification or eligibility in the prerequisite specialty is expected at the time of application or start. Confirm the specific requirement with each program, as policies differ.

Ideal Candidate Profile

Programs at dedicated amyloidosis centers are looking for trainees who have made a considered decision to specialize in this field rather than those using the position as an extension of general training. The strongest applicants typically have:

• Prior research exposure in amyloidosis, plasma cell dyscrasias, heart failure, or a directly relevant area—with at least one first-author or co-author publication or a submitted manuscript
• Clear articulation of why amyloidosis specifically, grounded in clinical or research experience rather than general interest in rare disease
• Letters of recommendation from faculty who know the amyloidosis field or who can speak to the applicant's translational research capacity
• Demonstrated interest in academic medicine; purely clinical-track applicants are possible but less common at research-intensive centers

Applicants whose prior fellowship was at an institution without amyloidosis volume should address this directly in their personal statement and ensure their letters speak to research productivity and clinical rigor as proxies for disease-specific experience.

Program Directory

The following are established centers with recognized amyloidosis training programs or significant dedicated clinical and research infrastructure. Accreditation status is noted for each. Program availability and structure change; confirm current offerings directly with each institution.

• Boston University Amyloidosis Center (Boston Medical Center): One of the highest-volume amyloidosis programs in the world. Offers institutional advanced fellowship positions (non-ACGME) in amyloidosis with strong AL, ATTR, and AA exposure. Research infrastructure includes longitudinal patient registries and active therapeutic trials.
• Mayo Clinic (Rochester, MN): Multidisciplinary amyloidosis program spanning hematology, cardiology, nephrology, and neurology. Training occurs through embedded concentrations within ACGME hematology/oncology and cardiovascular disease fellowships, as well as through institutional advanced fellowship arrangements. High case volume and translational research programs.
• Indiana University Amyloidosis and Rare Diseases (IUPUI): Dedicated amyloidosis clinical and research program with advanced training opportunities. Institutional non-ACGME advanced fellowship positions have been available. Notably active in systemic amyloidosis clinical trials.
• Stanford University (Palo Alto, CA): Cardiac amyloidosis program within the cardiovascular division, with active imaging and ATTR research. Training occurs through the ACGME cardiovascular disease fellowship with amyloidosis concentration opportunities.
• Memorial Sloan Kettering Cancer Center (New York, NY): AL amyloidosis training within the ACGME hematologic oncology fellowship, with plasma cell dyscrasia and amyloidosis volume that is among the highest in the country.
• University of California San Francisco (UCSF): Multidisciplinary amyloidosis program with hematology and cardiology components. Advanced training embedded within ACGME subspecialty fellowships.
• Tufts Medical Center (Boston, MA): Cardiac amyloidosis center with clinical volume and imaging expertise; cardiovascular fellowship training opportunities.

Outside the US, the UK National Amyloidosis Centre at University College London (Royal Free Hospital, London) is the largest single amyloidosis center globally and accepts international trainees through institutional arrangements. This is not a US GME pathway, but it is relevant for trainees who may pursue international rotations or whose training plan is international in scope.

Verify current program status, available positions, and application procedures directly with each institution. Program structures change as faculty move and funding evolves.

Application Process and Timeline

No Universal Application System

Stand-alone amyloidosis advanced fellowships do not use ERAS or the NRMP Match. Each program runs its own application process. This places full responsibility on the applicant to identify programs, make contact, and track deadlines independently.

Typical Timeline

Most programs recruit on an annual cycle, with applications reviewed in the calendar year preceding the intended start. Some programs recruit on a rolling basis when positions open. There is no standardized notification date. See the current season timeline on this site for context on when to begin outreach relative to your current fellowship year.

Early contact—reaching out to program directors or division chiefs to express interest and ask about upcoming positions—is both expected and strategically important in a small field where programs may not widely advertise openings.

Application Materials

Standard application packages for amyloidosis advanced fellowships include:

• Curriculum vitae: Full academic CV including publications, presentations, research funding, and teaching activities. Clinical productivity or case volume data are appropriate to include if available.
• Personal statement: A focused document (typically one to two pages) addressing your specific interest in amyloidosis, your relevant research or clinical background, and your career plan. Generic statements about rare diseases or systemic illness are weak; specificity about amyloid types and your prior exposure is expected.
• Letters of recommendation: Programs typically require three letters. At least one should be from a faculty member with amyloidosis field recognition if possible. Letters that speak to research capacity, clinical judgment, and independence are more useful than letters that only confirm clinical competence.
• Research summary or work samples: Some programs request an abstract, reprint, or brief research proposal. Prepare these in advance.

Making Contact

Email directly to the fellowship program director or division chief. Introduce yourself concisely, note your current training level and anticipated completion date, state your specific interest in amyloidosis (not hematology generally), and attach your CV. Follow up once if you do not receive a response within two to three weeks. In a small field, persistent professional contact is appropriate and not penalized.

What You Will Learn: Core Competencies

Amyloid Typing

Correct typing is the foundation of amyloidosis management because treatment is entirely type-specific. Trainees must develop fluency in:

• AL (light-chain) amyloidosis: recognition of the underlying plasma cell dyscrasia, interpretation of serum free light chains and immunofixation, bone marrow assessment
• ATTRv (hereditary transthyretin) amyloidosis: genetics, pathogenic variant identification, penetrance, and family counseling implications
• ATTRwt (wild-type transthyretin) amyloidosis: epidemiology, clinical presentation, and the practical workup algorithm in older adults with heart failure
• AA amyloidosis: identification and management of the underlying inflammatory condition
• Rarer types (ApoA-I, AFib, ALys, etc.): pattern recognition and referral logic

Diagnostic Workup

• Tissue biopsy strategy: abdominal fat pad aspiration, minor salivary gland, rectal, and organ-directed biopsies
• Congo red staining and polarized light microscopy interpretation
• Laser capture microdissection and mass spectrometry–based proteomics for definitive typing (the current gold standard for tissue-based typing)
• Technetium-labeled bone scan (DPD/PYP/HMDP) interpretation for ATTR cardiac amyloidosis
• Echocardiographic and cardiac MRI pattern recognition
• Genetic testing interpretation and genetic counseling coordination for TTR and other hereditary amyloidoses

Organ Involvement Assessment and Staging

Trainees learn systematic assessment of cardiac, renal, hepatic, neurologic, and soft tissue involvement using validated staging systems (Mayo cardiac staging for AL, Gillmore/NAC staging systems for ATTR) and how staging drives treatment urgency and sequencing decisions.

Therapeutics

• AL amyloidosis: daratumumab-based combination regimens (daratumumab/bortezomib/cyclophosphamide/dexamethasone and related protocols), autologous stem cell transplantation selection criteria and management
• ATTR amyloidosis: tafamidis and other TTR stabilizers, patisiran and vutrisiran (RNA interference), inotersen (antisense oligonucleotide), and emerging agents
• Supportive care: management of amyloid cardiomyopathy, nephrotic syndrome, and peripheral neuropathy in the context of amyloid disease
• Clinical trial participation and protocol management

Research and Academic Opportunities

Amyloidosis centers at major academic institutions are research-active environments. The field is in an active therapeutic development phase, with multiple agents in clinical trials across amyloid types. Trainees at dedicated programs can expect:

• Registry participation: Most major centers maintain longitudinal amyloidosis registries. Trainees contribute to data collection, analysis, and registry-derived publications.
• Clinical trials: High-volume centers are principal investigator sites for phase II and III trials. Trainees participate in protocol management, informed consent, and adverse event reporting, with opportunities for co-investigator roles.
• Translational research: Biomarker studies, mass spectrometry proteomics, amyloid fibril characterization, and correlative science tied to trial samples are available at centers with laboratory infrastructure.
• Publication output: A productive advanced fellowship year at a high-volume center should generate at least one to two first-author or co-first-author manuscripts. Programs that cannot point to recent fellow-driven publications should be asked directly about research support structure.

Trainees with strong research interest should ask specifically about protected research time (proportion of the week, number of months), access to biostatistics and research coordination support, and the mentor's current grant portfolio before accepting a position.

Salary, Funding, and Benefits

Compensation for amyloidosis advanced fellowship positions varies substantially depending on whether the position is structured as an ACGME-accredited fellowship, an institutional advanced fellowship, or a faculty appointment at a junior level.

• ACGME-accredited positions (where amyloidosis training is embedded within an accredited hematology/oncology or cardiovascular disease fellowship) carry ACGME salary floor protections and standard benefit structures. See the ACGME's published institutional requirements and your program's institutional data for specifics.
• Non-ACGME institutional advanced fellowship positions are not subject to ACGME salary standards. Compensation is set entirely by the sponsoring institution and varies widely. Some programs pay at ACGME-equivalent levels; others pay more (particularly if the position carries some clinical revenue generation) or less. Negotiate explicitly and get compensation and benefit terms in writing before accepting.
• NIH T32 funding: Some amyloidosis programs at research-intensive institutions are associated with T32 institutional training grants (typically in hematology, oncology, or cardiovascular medicine). T32 support provides a defined stipend level and covers some research-related expenses. Ask whether T32 support is available and whether you would be eligible.
• Industry-funded positions: Given the active therapeutic landscape in amyloidosis, some advanced training positions are partially supported by industry research contracts. Understand the scope of any industry relationship, publication rights, and independence before accepting a position with significant industry funding.

For current salary reference ranges, see this site's data pages rather than treating any figure here as current; compensation norms in non-ACGME advanced fellowships shift with institutional budgets and funding cycles.

Boards, Certification, and Career Outcomes

Certification

No standalone amyloidosis board certification exists. There is no ABIM, ACC, or other specialty board examination specific to amyloidosis. Trainees sit for—and must pass—the board examination of their primary ACGME-accredited subspecialty:

• Hematology/oncology or hematology trainees: ABIM subspecialty certification in hematology and/or medical oncology
• Cardiovascular disease trainees: ABIM subspecialty certification in cardiovascular disease
• Nephrology trainees: ABIM subspecialty certification in nephrology
• Neurology trainees: ABPN certification in neurology

Amyloidosis expertise is represented on the CV through fellowship training, publications, and clinical experience—not through a separate credential.

Career Trajectories

Physicians who complete dedicated amyloidosis training at high-volume centers typically pursue one or more of the following paths:

• Academic amyloidosis specialist at a referral center: Faculty appointment at a program with an established or developing amyloidosis center, carrying a mixed portfolio of clinical care, research, and teaching. This is the most common endpoint for fellowship graduates at Boston University, Mayo, and Indiana.
• Multidisciplinary center roles: Leadership or co-leadership of a multidisciplinary amyloidosis clinic combining hematology, cardiology, nephrology, and neurology. These roles exist at academic medical centers and are increasingly being created as ATTR recognition expands.
• Industry: Pharmaceutical and biotechnology companies developing amyloid-targeted therapies (TTR stabilizers, RNA therapeutics, anti-fibril antibodies) recruit amyloidosis specialists for medical affairs, clinical development, and advisory roles. An amyloidosis subspecialist with a publication record and trial experience is a competitive candidate for these positions.
• Community referral practice: Less common but present—some fellowship graduates build amyloidosis expertise within a broader hematology or cardiology practice at community academic centers, developing a regional referral catchment.

The field is small enough that most amyloidosis specialists know each other. Reputation built during fellowship—through publications, conference presentations, and direct professional relationships—has outsized career impact relative to larger subspecialties.

How to Evaluate a Program

Use the following checklist when comparing programs. Ask each question directly to the program director or current fellow, not just to recruiting materials.

• Case volume and amyloid type diversity: How many new amyloidosis diagnoses per year? What is the breakdown by type (AL, ATTRwt, ATTRv, AA, other)? A center with high AL volume but minimal ATTR exposure, or vice versa, produces a narrower skillset.
• Diagnostic infrastructure: Does the center have in-house mass spectrometry–based amyloid typing, or does it rely on send-out testing? In-house proteomics training is a significant differentiator.
• Multidisciplinary clinic structure: Does the program operate a true multidisciplinary amyloidosis clinic with cardiology, nephrology, neurology, and hematology at the table, or is it a single-specialty program that consults other services ad hoc? The former provides substantially broader training.
• Faculty mentorship and stability: Who are the primary mentors, and what is their current grant and publication activity? Have they mentored fellows to first-author publications? Are senior faculty planning to retire or leave within your training window?
• Protected research time: What percentage of the week is explicitly protected for research? Is this a written commitment or an informal understanding? How has protected time held up in practice for recent fellows?
• Active clinical trials: How many amyloidosis-specific trials are currently open? What is the fellow's role—screen and enroll only, or substantive co-investigator involvement?
• Alumni outcomes: Where are the last three to five fellows now? Are they in academic amyloidosis roles, industry, or general practice? Alumni trajectories are the most honest indicator of program quality and network strength.
• Contract terms for non-ACGME positions: Is compensation competitive? Are benefits (health insurance, malpractice, CME allowance) explicitly included? What are the terms for early departure? What dispute resolution mechanisms exist?

Interview Tips for Amyloidosis Fellowships

Amyloidosis fellowship interviews are substantive clinical and research conversations with faculty who are domain experts. The following are annotated models of how to approach common interview scenarios—not scripts, but structural principles with explanations of why each approach works.

Why amyloidosis specifically, rather than general hematology or cardiology?

Candidate approach: Ground the answer in a specific patient, case, or research experience that created a defined intellectual or clinical question. Then trace how pursuing that question led to a commitment to the field.

Why this works: It converts a generic interest statement into an evidence-based claim about your reasoning. Interviewers at specialized centers hear "I'm fascinated by rare diseases" frequently and discount it. A specific case or dataset demonstrates that your interest has already produced real engagement, not just enthusiasm.

Demonstrating familiarity with typing methods

Candidate approach: Be prepared to walk through a diagnostic algorithm—from initial Congo red–positive biopsy to definitive typing via mass spectrometry versus immunohistochemistry, and the clinical stakes of mistyping (treating AL with ATTR therapy, or vice versa).

Why this works: Mass spectrometry–based typing is the current standard at reference centers, and the clinical consequences of mistyping are severe. Demonstrating fluency with this shows you have engaged with the field at a meaningful level and are not starting from zero.

Discussing your research plan

Candidate approach: Come with a draft research question or area of interest that is relevant to the specific program's focus—not a generic "I want to do translational research." Reference a gap in the literature or an unanswered clinical question, and explain why this program's infrastructure or patient population would allow you to address it.

Why this works: It signals intellectual preparation and shows you have thought about fit specifically, not just prestige. It also gives the interviewer a natural opening to engage with your ideas, which shifts the interview from evaluation to intellectual dialogue—a dynamic that favors the candidate.

Handling gaps in disease-specific experience

Candidate approach: Name the gap directly and briefly, then pivot immediately to the relevant transferable experience and what you have done to close the gap (literature review, case series, conference attendance, direct patient encounters). Do not volunteer it unless asked, but do not deflect if the question is direct.

Why this works: Programs expect that applicants from non-amyloidosis–heavy fellowships will have limited disease-specific volume. What they are evaluating is whether you understand what you do not yet know and have taken reasonable steps to address it—a metacognitive quality that predicts successful independent learning.

Frequently Asked Questions

Can I apply for an amyloidosis advanced fellowship while I am still in my primary subspecialty fellowship?

Yes, and this is the standard timing. Most applicants apply during the final year of their ACGME-accredited subspecialty fellowship, with a start date following completion. Some programs recruit up to 18 months in advance of the start date. Initiating contact with programs early in your final fellowship year is appropriate.

Is amyloidosis a viable long-term specialty?

The honest answer is yes, with caveats. The field has genuine momentum: ATTR recognition has expanded substantially, approved therapeutics now exist for both AL and ATTR, and the pipeline of investigational agents is active. Academic amyloidosis specialists at high-volume centers have durable clinical and research portfolios.

The caveats are structural. The total number of dedicated amyloidosis faculty positions in the US is small. Most employment is at a handful of academic centers. If you are not prepared for an academic career or geographic flexibility, your options narrow significantly. The field also overlaps substantially with general hematology (for AL) and general cardiology (for ATTR), which means that some practitioners develop amyloidosis expertise within broader practices without a dedicated fellowship—so the fellowship is most clearly justified for those pursuing academic leadership or amyloidosis center roles.

How competitive are amyloidosis advanced fellowship positions?

The total number of positions is small—typically one to two per program per year at the major centers, with some years having no opening. This means the absolute number of spots nationally is in the low double digits at most. The applicant pool is self-selected and generally strong, but the programs are specific enough that a well-prepared, research-active applicant from a strong fellowship with a clear focus is not facing lottery-level odds. The process rewards direct relationship-building with program faculty more than most large-match subspecialties.

What makes a strong application?

In order of weight: a publication record demonstrating research productivity in a relevant area; letters from recognizable faculty who can speak to your intellectual capacity and independence; a personal statement that demonstrates specific, earned interest in amyloidosis rather than general interest in rare disease or plasma cell disorders; and any prior direct amyloidosis exposure (cases, research, conference presentations). A fellowship at an institution with no amyloidosis program is not disqualifying, but it places more weight on your research record and letters to demonstrate field-relevant capacity.

Can IMGs or international medical graduates apply to US amyloidosis advanced fellowships?

There is no categorical barrier for IMGs who have completed ACGME-accredited subspecialty training in the US and hold the prerequisite board eligibility. The same application standards apply. For trainees outside the US, institutional advanced fellowship arrangements may be possible at some centers, but these are entirely program-specific and not governed by standardized pathways. Verify current requirements directly with ECFMG/Intealth and official sources for your application year if visa status is relevant to your situation.