Citations

e19548 Background: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare lymphoma accounting for less than 1% of mature T-cell lymphomas. Its natural history is not understood due to lack of large studies with long-term followup and an optimal therapeutic approach is not well-defined. Methods: The National Cancer Database was queried for patients aged 18 years and older diagnosed with SPTCL between 2004 and 2018. We excluded patients who lost to follow-up. Kaplan-Meier and multivariate Cox regression were used in the analyses. Results: 353 patients with SPTCL were included. 63% were females, 62% Caucasian, and 26% African American, 50% had early stage (I and II) and 32% had advanced stage (III and IV). 58.4% received chemotherapy, 38.2% did not receive chemotherapy and 3.4% had unknown chemotherapy status. The median age at diagnosis was 49 years (range 18-90). The median overall survival (mOS) for the whole cohort was not reached In early-stage (N = 178), 49.5% had chemotherapy with 39% receiving single-agent chemotherapy and 60% receiving multi-agent chemotherapy. 18.5% received radiation. In advanced-stage (N = 112), 75.9% received chemotherapy with 19% receiving single-agent chemotherapy and 81% receiving multi-agent chemotherapy. 9.8% received radiation There was no significant difference in the mOS between advanced-stage and early-stage (161.5 months vs not reached, P = 0.051) In early stage, there was no significant difference in the OS between chemotherapy and no chemotherapy (mOS was not reached in both groups, P = 0.324). The same trend was seen in the advanced stage (mOS was not reached in both groups, P = 0.851) Compared to Caucasian, African American patients were younger (median age 47 vs 54 years), but there was no significant difference in disease stage, receiving chemotherapy or radiation or other disease related characteristics (IPI score, B-symptoms, and HIV infection). African American patients had better OS (mOS was not reached, P = 0.003). This significant difference was seen in early stage (mOS was not reached, P = 0.003), but not in advanced stage (mOS 162 vs 122 months, P = 0.113) On multivariate analysis, age and Charlson-Deyo score ≥3 were associated with worse OS (HR 1.028 95% CI 1.005-1.052; P = 0.018 and HR 14.711 95% CI 2.316-93.449; P = 0.004, respectively), whereas disease stage and chemotherapy status did not affect the OS (HR 0.938 95% CI 0.545-1.617; P = 0.819, HR 1.271 95% CI 0.175-9.255; P = 0.813, and HR 0.922 95% CI 0.489-1.738; P = 0.802, respectively). Conclusions: Our study indicates that SPTCL is predominantly an indolent lymphoma associated with long-term survival irrespective of stage and chemotherapy. A conservative therapeutic approach appears to be more appropriate than intensive therapeutic approach in most patients. A risk stratification algorithm is needed to determine the therapeutic intensity.

7543 Background: Total metabolic tumor volume (TMTV) and maximum standardized uptake value (SUVmax) may improve upon standard 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT)-based assessment of advanced DLBCL during treatment. We report the association of TMTV and SUVmax changes at interim PET-CT (PET2) on survival outcomes in patients with primary refractory DLBCL (prDLBCL) and early relapsing DLBCL (erDLBCL). Methods: Adult patients with prDLBCL (less than a complete response (CR) or progression by the end of treatment (EOT)) or erDLBCL (CR at EOT with relapse within 12 months) between 2005 and 2019 at Mayo Clinic Rochester were included. The % change (Δ) from baseline to PET2 (after 2 cycles of 1L therapy) of TMTV and SUVmax were measured. A PET segmentation threshold of 1.5 liver mean SUV + two standard deviations with a minimum volume constraint of 0.5 mL was utilized (MIM Software, Inc., Cleveland OH, USA) with manual input as needed. Functional splines analysis determined SUVmax and TMTV threshold for analysis. Results: 131 patients had complete PET-CT data (N=79 prDLBCL, N=52 erDLBCL). Baseline median TMTV and SUVmax were 767.4 cm3 (range 0.9-6840.4) and 20.5 (2.0-52.6), respectively. At a median follow up of 77.6 months, 81 patients had died. 2-year OS rate was 53% (95% CI: 42-67) for patients with a PET2 ΔSUVmax decline ≥65% compared to 15% (95% CI: 7-29) for patients with a PET2 ΔSUVmax decline <65%(p<0.001). PrDLBCL had a 2-year OS rate of 48% (95% CI: 31-74) for a ΔSUVmax ≥65% compared to 7% (95% CI: 2-21) for a ΔSUVmax <65%(p<0.001), which captured 58% of prDLBCL patients (N=46). Two-year OS rate was 43% (95% CI: 34-54) for patients with a ΔTMTV ≥75% compared to 5% (95% CI: 1-35) for patients with ΔTMTV <75% (p<0.001). All patients with a ΔTMTV <75% had prDLBCL. PrDLBCL had a 2-year OS rate of 28% (95% CI: 18-44) for a ΔTMTV ≥75%. The outcomes for ΔSUVmax <65% and ΔTMTV <75% at PET2 remained significant in a cox regression model adjusted for IPI and bulky disease (>10cm)(Table). Conclusions: A ΔTMTV decline <75% or a ΔSUVmax decline <65% at PET2 identified an ultra-high-risk subgroup of DLBCL with particularly poor outcomes, that captured a high percentage of prDLBCL patients, and was significant after adjusting for IPI and bulky baseline disease. These patients may benefit from clinical trials evaluating alternative PET-adapted treatment strategies, but further evaluation among all patients with DLBCL is needed. [Table: see text]

7016 Background: Many patients (pts) with myelofibrosis (MF) experience anemia resulting from disease or JAK inhibitor therapy. The open-label, phase 2 ACE-536-MF-001 study (NCT03194542) evaluated the safety and efficacy of luspatercept (LUSPA) for the treatment of MF-related anemia. Methods: Eligible pts comprised 4 cohorts based on transfusion dependence (TD, defined as receiving 4–12 red blood cell [RBC] units/84 days [d] immediately up to cycle 1 d 1) and stable ruxolitinib (RUX) treatment; cohort 1: no TD, no RUX; cohort 2: TD, no RUX; cohort 3A: no TD, RUX; cohort 3B: TD, RUX. Pts received subcutaneous LUSPA 1.0 mg/kg (1.33 mg/kg for pts in cohort 3B expansion) with titration up to 1.75 mg/kg in 21-d cycles. Disease response was assessed at d 169 and treatment extended for pts showing clinical benefit; pts were followed for ≥ 3 years (y) post last dose. The primary endpoint was anemia response (defined as 84 consecutive d: ≥ 1.5 g/dL hemoglobin [Hgb] from baseline without transfusion [cohorts 1 and 3A] or RBC transfusion-free [cohorts 2 and 3B]); secondary endpoints included duration of response (DOR), transfusion frequency, change in Hgb level, and symptom response. Results: Of 95 pts in the ITT group, the most common reason for treatment discontinuation was lack of clinical benefit at d 169 (n = 28). Median (range) age was 71.0 (50–89) y. Most (54.7%) pts had primary MF, intermediate-risk 2 disease (75.8%), and > 2 y since initial diagnosis (74.7%). Median prior RUX therapy was 18.1 months (cohorts 3A/3B) and 84.7% of pts had baseline transfusion burden 6–12 units/84 d (cohorts 2/3B). Mean treatment duration was 42.8 weeks. Cohort 3B had the highest anemia response rate with 26.3% (95% CI, 13.4–43.1) of pts transfusion independent during the primary treatment period and 31.6% (95% CI, 17.5–48.7) transfusion independent during the entire treatment period; median (range) DOR was 448 d (85–1582). In cohort 3B: 19 (50.0%) pts had reduced transfusion burden by ≥ 50% during the primary treatment period; 8 (21.1%) pts achieved mean Hgb increase ≥ 1.5 g/dL from baseline throughout the entire treatment period and 6 (15.8%) achieved a mean ≥ 50% reduction in symptom score from baseline. Overall, 47.4% of pts had ≥ 1 treatment-related adverse event (TRAE), most frequently hypertension (17.9%, 5.3% grade ≥ 3); 3.2% of pts had a serious TRAE. One TRAE led to LUSPA discontinuation. Two (2.1%) pts had transformation to acute myeloid leukemia. Nine pts died on treatment from: post-procedural hemorrhage, pneumonia, intracranial hemorrhage, septic shock, ischemic stroke, multiple organ dysfunction syndrome, renal failure, pneumonitis, and myelofibrosis (n = 1 each); no deaths were considered related to the study drug. Conclusions: In pts with MF, the safety profile of LUSPA was consistent with previous studies and efficacy results showed promising improvements in anemia and transfusion burden in all cohorts. Clinical trial information: NCT03194542 .

5094 Background: In prior studies, basal vs. luminal differentiation portends differential response to a) androgen suppression (AS) duration for high-risk prostate cancer (PCa) (NRG-GU-TS006) and b) docetaxel chemotherapy (CT) and AS for metastatic hormone-sensitive disease (CHAARTED). In NRG-GU-TS006, basal tumors appeared to benefit the most from longer duration of AS while those with luminal subtype did not whereas, in CHAARTED, luminal subtype had greater benefit from addition of CT. Herein, we examined basal-luminal subtyping to predict differential response to the addition of CT in the setting of high-risk PCa treated with AS and definitive radiotherapy (AS + RT) in NRG/RTOG 0521. Methods: Per pre-specified and approved NCI analysis plan (Navigator #1061), we obtained available NRG biobank biopsy specimens from patients enrolled on the NRG/RTOG 0521 phase III trial, which randomized patients to AS + RT +/- CT. The highest-grade tumors were profiled on clinical-grade whole-transcriptome arrays (Veracyte, San Diego, CA). Basal-luminal subtypes were generated using a 215-gene PCa subtyping classifier (PSC), a second generation PAM50 basal-luminal model. Treatment effects in Luminal Proliferating (LP) and non-LP subtypes were examined with Cox (for overall survival, OS, and metastasis-free survival, MFS) and Fine & Gray (for distant metastasis, DM) multivariable (MVA) models adjusted for age and trial risk stratification, as well as with restricted mean survival times (RMST). Results: Of 183 samples available for analysis (91 from control and 92 from the CT arm), 52 (28%) were classified as LP subtype. Median follow-up for OS was 9.9 years. No significant differences in clinical or pathological variables were observed between LP and non-LP subtypes. In MVA, we did not detect any significant LP subtype-by-CT treatment interaction but observed evidence of non-proportional hazards (Grambsch-Therneau test, p<0.05). In unselected patients, 5- and 10-year RMST difference between the arms was 0.9 (95% CI [-1.5, 3.4], p=0.46) and 5.7 (95% CI [-2.5, 13.9], p=0.17) months of OS. Stratifying by tumor subtype, at 5 years the RMST difference in months was 3.8 (95% CI [0.3, 7.2], p=0.03) for LP and -0.2 ([-3.4, 2.9], p=0.89) for non-LP. The RMST difference in months at 10-years was 13.7 (95% CI [-0.2, 27.5], p=0.053) for LP and 2.5 ([-7.6, 12.5], p=0.63) for non-LP. Conclusions: In pre-treatment biopsy samples from a Phase 3 trial cohort of localized high-risk men, luminal-basal subtyping of tumors demonstrated differential response to docetaxel CT. Similar to results from the CHAARTED trial of metastatic disease, LP tumors may derive greater benefit from addition of CT. Validation of these findings may enable effective earlier use of CT in men with PCa.

4027 Background: DKN-01 is an anti-DKK1 mAb which has demonstrated anti-tumor activity in patients with advanced GEA with low tumor PD-L1 expression, a subset with very limited therapeutic options. DKN-01 has immunomodulatory activity, stimulates a pro-inflammatory tumor microenvironment, and upregulates PD-L1 levels. Here we present 2-year survival data for 1L advanced GEA patients who received combination treatment with DKN-01, the Fc-optimized anti-PD-1 tislelizumab, and CAPOX chemotherapy. The ORR was previously reported (68% in ITT and 79% in PD-L1-low populations). Methods: This Phase 2, multi-center, single arm Part A of the DisTinGuish (NCT04363801) study investigated DKN-01 + tislelizumab + CAPOX as 1L therapy in advanced HER2(-) GEA, regardless of DKK1 and PD-L1 expression levels. Tumor DKK1 and PD-L1 were assessed by central laboratories. The primary endpoint was ORR in a modified intent to treat population (>1 dose DKN-01); secondary endpoints included PFS and OS in the ITT population. Results: Twenty-five patients were enrolled from September 2020 to April 2021. As of 23 January 2023: Median age was 61 years (22, 80); 17 patients had GEJ adenocarcinoma; 8 had gastric cancer. Twenty-one patients had tumors with evaluable DKK1 expression. Twenty-two patients had tumors with evaluable PD-L1 expression; the majority (73%) were low expressors (vCPS <5%). Median (m) duration on treatment is 11.3 months (mo). Seven patients remain on study, with 4 on-treatment beyond 2 years. The mPFS is 11.3 mo in the overall ITT population and 10.7 mo in patients with low tumor PD-L1 expression. The mOS is 19.5 mo in the overall ITT population and 18.7 mo in the patients with low tumor PD-L1 expression. Treatment related adverse events (TRAEs) were mild with most G1/2. The most common AEs related to the study drug regimen were nausea (72%), diarrhea (64%) and fatigue (60%). Five patients experienced G3 DKN-01-TRAEs including decreased neutrophil count (1), diarrhea (1), vomiting (1), hypophosphatemia (2), and pulmonary embolism (1). Conclusions: At 2-years of follow-up, 1L treatment of advanced GEA patients with DKN-01 in combination with tislelizumab and CAPOX resulted in a prolongation of PFS and OS compared with the modern SOC regimen of nivolumab plus chemotherapy, both in the overall population (mPFS 11.3 vs 7.7 mo; mOS 19.5 vs 13.8 mo) and in the PD-L1 low subgroup (mPFS 10.7 vs 7.5 mo; mOS 18.7 vs 12.4 mo), alongside a manageable safety profile. The prolonged PFS and OS observed in the current study are notable, especially in our trial population dominated by patients with tumors of low PD-L1 expression, where the known benefit of anti-PD-1 therapy is limited. The ongoing Part C of this study is evaluating mFOLFOX6/CAPOX plus tislelizumab with or without DKN-01 in the same 1L GEA patient population. Further evaluation of biomarkers is also ongoing. Clinical trial information: NCT04363801 .

e14576 Background: Immune checkpoint inhibitors (ICI) have revolutionized the treatment of many solid malignancies. ICI appears particularly effective when tumors exhibit high microsatellite instability (MSI-H) and/or mismatch repair deficient (dMMR) status. Although the response is typically quite good in this setting, there are scenarios where benefit is less than anticipated. In this study, we aimed to explore the efficacy of ICIs in patients with MSI-H/dMMR cancers with peritoneal metastasis (PM). Methods: We conducted a retrospective chart review to identify patients (pts) with PM from primary MSI-H/dMMR cancers treated with immunotherapy between 2010 and 2022 at Mayo Clinic. Data was collected to include pt demographics, tumor characteristics, pathology, tumor markers, imaging, mutational profile, and previous and subsequent treatments. The primary endpoint was disease control rate (DCR), defined as objective response rate (RECIST v1.1 criteria) or stable disease. Results: Forty-six pts with MSI-H/dMMR and PM treated with ICIs. Most of our cohort were female (61%) with a median age at diagnosis of 61 years. Colorectal cancer was the most common primary site (69.6%), followed by endometrial (6.5%). Most pts received treatment with PD-1 antibodies as second-line therapy following systemic chemotherapy. DCR of the PM was 71.6 % (n= 13 PR, 9 CR, and 9 SD), with a median duration of response of 12.6 months. Thirteen pts (28.4%) had progressive peritoneal disease on ICI with a median PFS of 2.2 months. Ascites was a poor prognosticator and predicted a lack of benefit from ICI (HR 6.6, 95% CI=2.24-19.9, p= 0.006). Mucinous and signet ring histology were common in pts with peritoneal progression (61.5%); however, this was not statistically significant (HR=1.6; 95%CI= 0.4383 to 3.899, p 0.5). Multivariate analysis for the presence or absence of BRAF and/or RAS mutations was not statistically significant in predicting response. Neither was the specific MMR gene mutation(i.e., MLH1 or PMS2). Interestingly, discordant responses between the peritoneum and other sites of metastasis to immunotherapy were seen in 13 pts (28.4%), primarily as primary peritoneal progression compared to other tumor sites. Conclusions: In our cohort, the DCR of metastatic peritoneal disease in MSI-H/dMMR tumors was approximately 71%. The presence of ascites was identified as a poor prognosticator in this setting and was associated with a lack of response/benefit from ICIs. Histologic subtype (i.e., mucinous/signet ring) did not show statistical significance in predicting ICI response. The subpopulation with discordant response to ICI suggests that peritoneal immunobiology may differ from other sites. Further research on immunotherapy response in the peritoneum is needed for this special subset of pts.

2062 Background: While cancer therapeutics have made tremendous progress within the past several decades, this benefit has not been seen in many primary cancers of the brain. Particularly confounding have been high-grade gliomas (HGG), which retain a dismal prognosis. Currently, novel therapies are being explored to rise to this unmet, critical need. One such therapy are CAR T cells, immune cells which have been engineered to target malignancy-specific antigens. Unfortunately, the efficacy of CAR T cell therapies against solid tumors is significantly limited, in large part due to impaired expansion/persistence in the immune suppressive tumor microenvironment (TME). Here we show that in vivo reactivation of CAR T cells through their native T Cell Receptor (TCR) by an oncolytic virus (OV) has therapeutic benefit in HGG. Methods: An EGFRvIII third-generation MSGV1 retroviral CAR construct containing the CD28, 4-1BB, and CD3z moieties, in tandem with the scFv derived from the human monoclonal antibody 139 and the marker Thy1.1 (38) was used to generate our CAR T cells. C57Bl/6 mice were used for in vivo experiments and both B16- and CT2A-EGFRvIII murine glioma cell lines were injected in the brain to model HGG. OVs and CAR T cells were given systemically by tail vein. OVs used include reovirus, vesicular stomatitis virus, and adenovirus. Results: By using OV in combination with EGFRvIII CAR T cells, we were able to generate a CD8 CAR population with TCR specificity for both the EGFRvIII and OV epitopes. These dual-specific (DS) CAR T expressed a memory phenotype and persisted for much longer than conventional CAR T cells. Further, we showed that these DS CAR T cells are more cytotoxic and can respond more rapidly than their conventional counterparts. We created a novel delivery mechanism for this combination OV + CAR T therapy using virus-loaded CAR T cells to bypass initial antiviral clearance from the immune system. Treatment with these OV-loaded CAR T cells lead to significant benefit in mice with HGG tumors which could be further enhanced by a systemic boost with OV, which rapidly re-activated DS CAR T cells against tumor and resulted in long-term cures of greater than 80% of treated animals. Conclusions: These promising results show that DS CAR T cells can overcome the critical therapeutic challenge of CAR T as a treatment for solid tumors. Given these promising results, we will go on to develop a clinical trial in which CAR T cells will be pre-loaded with OV and administered intravenously to patients with HGG, followed by systemic boosting with virus to re-activate DS CAR T cells against their tumor.

Abstract Background Rifampin-resistant tuberculosis is a leading cause of morbidity worldwide; only one-third of persons start treatment, and outcomes are often inadequate. Several trials demonstrate 90% efficacy using an all-oral, 6-month regimen of bedaquiline, pretomanid, and linezolid (BPaL), but significant toxicity occurred using 1200-mg linezolid. After US Food and Drug Administration approval in 2019, some US clinicians rapidly implemented BPaL using an initial 600-mg linezolid dose adjusted by serum drug concentrations and clinical monitoring. Methods Data from US patients treated with BPaL between 14 October 2019 and 30 April 2022 were compiled and analyzed by the BPaL Implementation Group (BIG), including baseline examination and laboratory, electrocardiographic, and clinical monitoring throughout treatment and follow-up. Linezolid dosing and clinical management was provider driven, and most patients had linezolid adjusted by therapeutic drug monitoring. Results Of 70 patients starting BPaL, 2 changed to rifampin-based therapy, 68 (97.1%) completed BPaL, and 2 of the 68 (2.9%) experienced relapse after completion. Using an initial 600-mg linezolid dose daily adjusted by therapeutic drug monitoring and careful clinical and laboratory monitoring for adverse effects, supportive care, and expert consultation throughout BPaL treatment, 3 patients (4.4%) with hematologic toxicity and 4 (5.9%) with neurotoxicity required a change in linezolid dose or frequency. The median BPaL duration was 6 months. Conclusions BPaL has transformed treatment for rifampin-resistant or intolerant tuberculosis. In this cohort, effective treatment required less than half the duration recommended in 2019 US guidelines for drug-resistant tuberculosis. Use of individualized linezolid dosing and monitoring likely enhanced safety and treatment completion. The BIG cohort demonstrates that early implementation of new tuberculosis treatments in the United States is feasible.

Increased cognitive hyperarousal is a proposed mechanism associated with clinical poor sleep including insomnia. An objective marker of nocturnal hyperarousal is high frequency electroencephalography during sleep, including increased beta frequency during stage two (N2) sleep. Acute and chronic poor sleep quality are associated with autonomic dysfunction, but little is known regarding the relationship between nocturnal beta frequency intrusion and nocturnal autonomic function. The purpose of this study was to explore the association between beta spectral power during stage two (N2) sleep and nocturnal heart rate variability (HRV) in healthy female and male adults. We hypothesized that heightened beta spectral power during N2 sleep would be associated with reduced nocturnal HRV. Twenty-four participants (12 males, 12 females; age, 25 ± 1 years; BMI 27 ± 1 kg/m2) underwent an 8-hour overnight sleep opportunity with continuous polysomnography and 5-lead electrocardiogram monitoring. Periods of 5 – 10 minutes of stable N2 sleep absent of cortical arousals, respiratory events, and limb movement-associated arousals were identified (one per cycle) for analysis. Periods from the first two cycles of N2 sleep from the full night were selected for analysis. Beta spectral power from the central and frontal regions and nocturnal HRV data were analyzed and averaged across each hemisphere. Time-domain HRV was quantified as the root mean squared of successive differences (RMSSD) and proportion of R-R intervals (RRI) varying by greater than 50 ms (pNN50). An inverse correlation was observed between central beta power and RRI (R= -0.473, p=0.019), pNN50 (R= -0.450, p=0.028), and RMSSD (R= -0.406, p=0.049). This was paralleled by a similar relationship between frontal beta and RRI (R= -0.487, p=0.016) and pNN50 (R= -0.423, p=0.039). Our results indicate a negative association between N2 beta power and nocturnal HRV measures. These findings suggest that nocturnal hyperarousal may be associated with poor cardiac autonomic function and has implications for individuals with insomnia in whom cognitive hyperarousal is frequently reported. Support is provided by the National Institutes of Health (AA-024892, U54GM115371; P20GM103474, 2TL1 TR002318). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Heightened anxiety is associated with an increased risk for cardiovascular diseases such as coronary heart disease and hypertension. While hyperactivity of the sympathetic nervous system has been suggested to mediate this relationship, direct measures of muscle sympathetic nerve activity (MSNA) in people with elevated anxiety have indicated little, if any, alterations in baseline sympathetic function. However, studies examining anxiety and MSNA have been limited by small sample sizes and lack of detail on anxiety severity, limiting the ability to investigate subtle interactions. The present study assessed associations between trait anxiety, mean arterial pressure (MAP), and MSNA using a large, representative sample of healthy young men and women, with an exploratory assessment of sex-specific interactions. We hypothesized that heightened trait anxiety would be associated with elevated resting MAP and MSNA. Trait anxiety was assessed using the Spielberger Trait Anxiety Inventory (STAI) in 97 healthy adults (52 male, 45 female; 25±1 years; 26±1 kg/m2). In each participant, the average of three seated brachial blood pressures was recorded and used in subsequent analysis. All participants underwent an autonomic function test that simultaneously assessed heart rate (HR), beat-to-beat blood pressure, MSNA burst frequency (BF) and incidence (BI) during 5-10 minutes of supine rest. MSNA recordings were captured in 91 participants. Multiple regression was used to test the relationship between STAI, MAP, MSNA, and HR while accounting for age and sex. Sex-specific interactions were explored with correlations controlling for age. The regression model significantly predicted MAP (R2=.196, P<0.001), BF (R2=.136, P=0.005), and BI (R2=.150, P=0.003), but not HR (R2=.055, P=0.155). STAI scores were independently associated with MAP (β=.207, P=0.029), BF (β=.245, P=0.016), and BI (β=.224, P=0.027). In males, STAI was correlated with MAP (R=.277, P=0.049), BF (R=.363, P=0.009), and BI (R=.346, P=0.013), but not HR (R=.140, P=0.326). In contrast, STAI was not associated with MAP (R=.174, P=0.260), BF (R=.094, P=0.574), BI (R=.069, P=0.681), or HR (R=.226, P=0.141) in females. In a large sample of healthy adults, our results highlight the relationship between the severity of trait anxiety, resting blood pressure, and sympathetic outflow, with a more pronounced relationship in males. Support: NIH (AA-024892, 1R15HL140596-01, AG064038-01A1, U54GM115371; P20GM103474, 2TL1 TR002318). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.