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) andwhich are associated with leukocytosis indicate that most are granulocyteCSF-producing tumors. A 71-year-old man with metastatic chest wall tumorsfrom large cell lung cancer with marked leukocytosis and eosinophilia wasreported. His maximal leukocyte count was 48300/microliter with 37.5%eosinophils. Granulocyte-macrophage CSF (GM-CSF) activity detected byenzyme-linked immunosorbent assay (ELISA) in serum was 112 pg/ml (normalrange < 2.0 pg/ml), but G-CSF was normal. Immunohistochemical detectionof GM-CSF protein on a chest wall tumor sample was positive. Irradiation ofthe chest wall tumor was performed and the leukocyte count decreasedtemporally. However, he died of respiratory failure due to progressivetumor growth 56 days after admission. Based on these results it appearsthat autocrine production of GM-CSF is a possible cause of this leukemoidreaction.