PRODUCTION OF GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR IN A PATIENT WITH METASTATIC CHEST-WALL LARGE-CELL CARCINOMA

Recent reports of cancers that produce colony-stimulating factors (CSF ) and which are associated with leukocytosis indicate that most are gr anulocyte CSF-producing tumors. A 71-year-old man with metastatic ches t wall tumors from large cell lung cancer with marked leukocytosis and eosinophilia was reported. His maximal leukocyte count was 48 300/mu l with 37.5% eosinophils. Granulocyte-macrophage CSF (GM-CSF) activity detected by enzyme-linked immunosorbent assay (ELISA) in serum was 11 2 pg/ml (normal range <2.0 pg/ml), but G-CSF was normal. Immunohistoch emical detection of GM-CSF protein on a chest wall tumor sample was po sitive. Irradiation of the chest wall tumor was performed and the leuk ocyte count decreased temporally. However, he died of respiratory fail ure due to progressive tumor growth 56 days after admission. Based on these results it appears that autocrine production of GM-CSF is a poss ible cause of this leukemoid reaction.