CD16⁺ monocytes in patients with cancer: Spontaneous elevation and pharmacologic induction by recombinant human macrophage colony-stimulating factor

The small subset of circulating monocytes that express the maturation- associated CD16 antigen has recently been reported to be elevated in patients with bacterial sepsis. We now show that this novel CD16⁺ monocyte population is also spontaneously expanded in patients with cancer. We studied 14 patients with metastatic gastrointestinal carcinoma enrolled in a clinical trial of recombinant human macrophage colony-stimulating factor (rhMCSF) plus monoclonal antibody D612. We found that before any cytokine treatment, 12 of 14 patients constitutively displayed significant elevations in both the percentage and the absolute number of CD16⁺ monocytes, as compared with both normal subjects and ill patients with elevated monocyte counts but without malignancy. CD16⁺ monocytes accounted for 46% ± 22% of total monocytes in the patients with cancer versus 5% ± 3% for controls (P < .01). The increase was not attributable to infection or intercurrent illness and appeared to be associated with the underlying malignancy itself. A similar spontaneous elevation of CD16⁺ monocytes was observed in 35 of 44 additional patients diagnosed with a variety of other solid tumors. When patients with gastrointestinal carcinoma were treated with rhMCSF, there was a marked further increase in the percentage of CD16⁺ monocytes (to 83% ± 11%), as well as in the absolute number of CD16⁺ cells and the level of CD16 antigen expression. In every case, the patients with cancer showed a greater CD16⁺ monocyte response than the maximal response obtained in normal volunteer subjects treated with a similar regimen of rhMCSF (n = 5, P < .001), suggesting that the presence of malignancy primed patients for enhanced responsiveness to rhMCSF. We hypothesize that spontaneous expansion of the CD16⁺ monocyte population may represent a novel biologic marker for a widespread and previously unsuspected host immune response to malignancy.