This variant, c.2646+2T>A, alters the canonical donor splice site of intron 18. RT-PCR analysis revealed that the variant results in the use of a cryptic splice site in exon 18, deleting the last 21 nucleotides of the exon, corresponding to the loss of 7 amino acids (PMID 11854868). As <10% of the protein in lost, PVS1_Moderate was applied. The variant is not in gnomAD v2.1.1, meeting PM2. Four individuals with this variant have been reported to have Pompe disease and residual GAA activity meeting the ClinGen LSD VCEP's specifications for PP4. These individuals are compound heterozygous for the variant and another pathogenic variant in GAA, either an 8 kb deletion extending from intron 7 to intron 15 (PMID 11854868; in trans, 1 point), c.2481+102_2646+31del (PMID 17616415; phase unknown), c.573C>A (p.Tyr191Ter) (PMID 11738358; phase unknown), and c.1942G>A (p.Gly648Ser) (PMID 29422078; note that in trans data from this patient will be used in the classification of p.Gly648Ser and is not included here in order to avoid a circular argument). This in trans data meets PM3_Strong. Another patient has been reported but was not included because the residual GAA activity was not provided and therefore PP4 cannot be assessed (PMID 28380188). There is a ClinVar entry for this variant (Variation ID: 188924, 1 star status) with one submitter classifying the variant as likely pathogenic. In summary, this variant meets the criteria to be classified as likely pathogenic for Pompe disease. GAA-specific ACMG/AMP criteria applied, as specified by the ClinGen LSD VCEP: PVS1_Moderate, PM2, PM3_Strong, PP4.