Leukemia--Chronic Lymphocytic

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Early Detection, Diagnosis, and Staging TOPICS

Signs and symptoms of chronic lymphocytic leukemia

Even when people with CLL have symptoms, they are often vague and can be symptoms of other things. Symptoms can include the following:

  • Weakness
  • Feeling tired
  • Weight loss
  • Fever
  • Night sweats
  • Enlarged lymph nodes (often felt as lumps under the skin)
  • Pain or a sense of "fullness" in the belly (this can make someone feel full after only a small meal), which is caused by an enlarged spleen

Many of the signs and symptoms of advanced CLL occur because the leukemia cells replace the bone marrow's normal blood-making cells. As a result, people do not make enough red blood cells, properly functioning white blood cells, and blood platelets.

  • Anemia is a shortage of red blood cells. It can cause tiredness, weakness, and shortness of breath.
  • A shortage of normal white blood cells (leukopenia) increases the risk of infections. You might hear the term neutropenia, which refers specifically to low levels of neutrophils (a type of granulocyte needed to fight bacterial infections). Patients with CLL may have very high white blood cell counts because of excess numbers of lymphocytes (lymphocytosis), but the leukemia cells do not protect against infection the way normal white blood cells do.
  • A shortage of blood platelets (thrombocytopenia) can lead to excess bruising, bleeding, frequent or severe nosebleeds, and bleeding gums.

People with CLL have a higher risk of infections. This is mainly because their immune systems are not working as well as they should. CLL is a cancer of B lymphocytes, which normally make antibodies that help fight infection. But in CLL, these antibody-making cells don't work as they should, so they can't fight infections well. Infections may range from simple things like frequent colds or cold sores to pneumonia and other serious infections.

CLL may also affect the immune system in other ways. In some people with CLL, the immune system cells make abnormal antibodies that attack normal blood cells. This is known as autoimmunity. It can lead to low blood counts. If the antibodies attack red blood cells, it is known as autoimmune hemolytic anemia. Less often, the antibodies attack platelets and the cells that make them, leading to low platelet counts. Rarely, the antibodies attack white blood cells, leading to leukopenia (low white blood cell counts).

CLL often enlarges the liver or spleen. If these organs are enlarged, you may notice fullness or swelling of the belly. You may also notice that you feel full after only a small meal. The spleen is on the left side, while the liver is on the right. These organs are usually covered by the lower ribs but when they are larger than normal your doctor can feel them.

CLL will often invade the lymph nodes enlarging them. If the nodes are close to the surface of the body (for instance, on the sides of the neck, in the groin, in the underarm area, or above the collarbone), you or your doctor may notice them as lumps under the skin. Lymph nodes inside the chest or abdomen may also become swollen, but these can be found only by imaging tests such as a computed tomography (CT) scan.

These symptoms and signs may be caused by CLL, but they can also be caused by other conditions. Still, if you have any of these problems, it's important to see your doctor right away so the cause can be found and treated, if needed.


Last Medical Review: 07/31/2013
Last Revised: 02/14/2014