10 Common Symptoms of Acute Lymphocytic Leukemia You Should Know

Acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia, is a type of blood cancer that affects white blood cells called lymphocytes. This condition progresses rapidly and requires prompt medical attention. Understanding the symptoms of ALL is crucial for early detection and timely intervention.

ALL occurs when bone marrow produces too many immature lymphocytes that don’t function properly. These abnormal cells accumulate in the blood and bone marrow, crowding out healthy blood cells. While ALL can affect people of any age, it is the most common type of leukemia in children, though it also occurs in adults.

Recognizing the warning signs of acute lymphoblastic leukemia can make a significant difference in outcomes. Below are the most common symptoms associated with this condition.

1. Persistent Fatigue and Weakness

One of the earliest and most common symptoms of acute lymphocytic leukemia is extreme tiredness that doesn’t improve with rest. This fatigue occurs because the leukemia cells crowd out healthy red blood cells, leading to anemia.

Patients often describe this exhaustion as overwhelming and debilitating. Simple daily activities like walking up stairs, getting dressed, or performing routine tasks may become challenging. The weakness may be accompanied by:

• Shortness of breath during normal activities
• Dizziness or lightheadedness
• Pale skin or pale lips
• Difficulty concentrating or mental fog

This symptom progressively worsens as the disease advances and more healthy blood cells are replaced by cancerous ones.

2. Frequent Infections and Fever

People with ALL often experience recurrent infections that may seem unusual in frequency or severity. This happens because the abnormal lymphocytes cannot fight infections effectively, even though they are present in large numbers.

Common manifestations include:

• Persistent or recurring fevers without an obvious cause
• Frequent respiratory infections like pneumonia or bronchitis
• Skin infections that develop easily or heal slowly
• Mouth sores or gum infections
• Urinary tract infections

The fever associated with ALL may come and go, and patients might experience night sweats. These infections can range from mild to severe and may not respond well to standard antibiotic treatments.

3. Easy Bruising and Bleeding

Unexplained bruising and bleeding problems are hallmark symptoms of acute leukemia. This occurs because ALL reduces the production of platelets, which are essential for blood clotting.

Patients may notice:

• Bruises appearing with minimal or no trauma
• Large bruises (purpura) or small red spots under the skin (petechiae)
• Prolonged bleeding from minor cuts or scratches
• Frequent nosebleeds that are difficult to stop
• Bleeding gums, especially when brushing teeth
• Heavy menstrual periods in women
• Blood in urine or stool

The bruises may appear purple, blue, or yellowish and can develop in unusual locations without any remembered injury.

4. Bone and Joint Pain

Many people with acute lymphoblastic leukemia experience significant bone and joint pain, particularly in the long bones of the arms and legs. This pain results from the accumulation of leukemia cells in the bone marrow, which causes pressure and inflammation.

The pain characteristics include:

• Deep, aching pain in bones, especially at night
• Joint pain and stiffness, particularly in knees, hips, and shoulders
• Pain that may migrate from one location to another
• Tenderness when pressure is applied to bones
• Limping or difficulty walking in children

In children, this symptom is sometimes initially mistaken for growing pains or sports injuries. The pain can range from mild discomfort to severe pain that interferes with daily activities and sleep.

5. Swollen Lymph Nodes

Enlarged lymph nodes are a common finding in ALL patients. The lymph nodes may become swollen as leukemia cells accumulate in the lymphatic system. These swollen nodes are typically painless and firm to the touch.

Areas where swelling commonly occurs:

• Neck (most common location)
• Underarms (axillary region)
• Groin area
• Above the collarbone (supraclavicular)

The swollen lymph nodes may be visible as lumps under the skin or detected during physical examination. Unlike lymph node swelling from infections, these enlarged nodes typically don’t become red, warm, or tender, and they don’t shrink after a few weeks.

6. Abdominal Swelling and Discomfort

Acute lymphocytic leukemia can cause enlargement of the liver (hepatomegaly) and spleen (splenomegaly), leading to abdominal symptoms. As these organs become infiltrated with leukemia cells, they expand beyond their normal size.

Patients may experience:

• Feeling of fullness or bloating, even after eating small amounts
• Visible swelling or distension of the abdomen
• Discomfort or pain in the upper left side (enlarged spleen) or upper right side (enlarged liver)
• Loss of appetite
• Early satiety (feeling full quickly when eating)

The abdominal swelling may be gradual and become more noticeable over time. In some cases, the enlarged spleen can be felt as a mass below the left rib cage.

7. Unexplained Weight Loss

Significant, unintentional weight loss is another warning sign of ALL. This occurs due to multiple factors related to the disease process.

The weight loss in acute leukemia patients typically involves:

• Loss of 10% or more of body weight over a short period without dieting
• Decreased appetite and reduced food intake
• Changes in metabolism caused by cancer cells
• Early fullness due to enlarged organs

This symptom is often accompanied by general weakness and muscle wasting. Children with ALL may fail to gain weight appropriately or may lose weight despite adequate caloric intake.

8. Shortness of Breath

Difficulty breathing or shortness of breath (dyspnea) is a common symptom that results from anemia and, in some cases, from leukemia cells accumulating in the chest area.

Respiratory symptoms may include:

• Breathlessness during mild physical activity or even at rest
• Rapid breathing or feeling unable to catch one’s breath
• Chest tightness or discomfort
• Persistent cough
• Wheezing in some cases

In severe cases, leukemia cells can infiltrate the thymus gland or accumulate in the mediastinum (the area between the lungs), creating a mass that can compress the airways and major blood vessels. This is considered a medical emergency requiring immediate attention.

9. Neurological Symptoms

When acute lymphoblastic leukemia spreads to the central nervous system (CNS), it can cause various neurological symptoms. CNS involvement occurs when leukemia cells cross the blood-brain barrier and infiltrate the brain or spinal cord.

Neurological manifestations may include:

• Severe, persistent headaches
• Blurred vision or other visual disturbances
• Dizziness or problems with balance
• Seizures
• Vomiting, especially in the morning
• Weakness or numbness in the face, arms, or legs
• Confusion or changes in mental status

These symptoms occur in a subset of ALL patients and indicate more advanced disease. Children may become irritable, have difficulty concentrating, or show changes in behavior or school performance.

10. Skin Changes and Rashes

Some patients with acute lymphocytic leukemia develop skin-related symptoms. These changes occur when leukemia cells infiltrate the skin or when the disease affects blood clotting and circulation.

Skin manifestations include:

• Small red or purple spots (petechiae) that don’t blanch when pressed
• Larger purple patches (purpura)
• Pale or sallow skin tone due to anemia
• Lumps or nodules under the skin (leukemia cutis)
• Increased susceptibility to skin infections
• Slow healing of wounds or cuts

Petechiae typically appear on the legs, feet, arms, and trunk, and may resemble a rash. Unlike a typical rash, these spots don’t fade when pressure is applied and don’t itch.

Main Causes of Acute Lymphocytic Leukemia

The exact cause of acute lymphoblastic leukemia remains unknown in most cases. However, researchers have identified several factors that may increase the risk of developing this condition:

Genetic Factors:

• Inherited genetic syndromes such as Down syndrome, Li-Fraumeni syndrome, or neurofibromatosis
• Certain inherited immune system disorders
• Having an identical twin with ALL, especially if diagnosed before age 6

Environmental Exposures:

• Previous exposure to high levels of radiation, including radiation therapy for other cancers
• Exposure to certain chemicals like benzene
• Previous chemotherapy treatment for other cancers

Acquired Gene Mutations:

• Random mutations in lymphocyte DNA that occur after birth
• Chromosomal translocations (such as the Philadelphia chromosome)
• These mutations are not inherited but develop during a person’s lifetime

Other Risk Factors:

• Age: ALL is most common in children under 5 years old, with another peak in adults over 50
• Gender: slightly more common in males than females
• Ethnicity: more common in Caucasians and Hispanics
• Previous blood disorders

It’s important to note that having one or more risk factors doesn’t mean a person will definitely develop ALL. Many people with risk factors never develop the disease, while others with no known risk factors do develop it.

Frequently Asked Questions

How quickly do ALL symptoms develop?

Acute lymphoblastic leukemia symptoms typically develop rapidly, often over a period of weeks to a few months. This is why it’s called “acute” – the disease progresses quickly and requires prompt medical attention. Some symptoms like fatigue may appear gradually, while others like fever and bleeding may develop more suddenly.

Can ALL symptoms come and go?

While some symptoms like fever may fluctuate, most ALL symptoms tend to persist and worsen over time if left untreated. The progressive nature of symptoms is one characteristic that distinguishes ALL from less serious conditions. If you experience symptoms that seem to improve temporarily but keep returning, medical evaluation is important.

Are ALL symptoms different in children versus adults?

The core symptoms of ALL are similar in both children and adults, but presentation may vary. Children often complain of bone pain, may refuse to walk or appear to limp, and might be irritable or lethargic. Adults may notice more subtle symptoms initially, such as gradually increasing fatigue. Children are also more likely to present with fever and infections.

How is ALL diagnosed if symptoms are similar to other conditions?

Because ALL symptoms can mimic other illnesses, diagnosis requires specific blood tests and bone marrow examination. A complete blood count (CBC) typically shows abnormal numbers of blood cells. Diagnosis is confirmed through bone marrow aspiration and biopsy, which examines cells under a microscope and performs specialized tests to identify leukemia cells and their specific characteristics.

When should I see a doctor about possible ALL symptoms?

You should consult a healthcare provider if you experience persistent symptoms such as unexplained fatigue lasting more than two weeks, frequent infections, easy bruising or bleeding, bone pain, or swollen lymph nodes that don’t resolve. In children, seek medical attention for persistent fever, limping, refusal to use a limb, or unexplained irritability along with other symptoms.

Can ALL be detected before symptoms appear?

Acute lymphoblastic leukemia typically is not detected before symptoms appear because there are no routine screening tests for this condition in the general population. Unlike some cancers, ALL is not usually found during routine check-ups unless blood tests happen to be done for another reason and show abnormalities.

What should I do if I suspect I have ALL symptoms?

If you’re experiencing several symptoms consistent with ALL, schedule an appointment with your primary care physician as soon as possible. Don’t wait to see if symptoms resolve on their own. Your doctor can perform initial blood tests and refer you to a hematologist-oncologist (blood cancer specialist) if needed for further evaluation and proper diagnosis.

Are there conditions that mimic ALL symptoms?

Yes, several conditions can cause similar symptoms to ALL, including other types of anemia, viral infections like mononucleosis, immune system disorders, other types of cancer, and various blood disorders. This is why professional medical evaluation and testing are essential for accurate diagnosis. Never attempt to self-diagnose based on symptoms alone.

References:

• American Cancer Society – Acute Lymphocytic Leukemia
• Mayo Clinic – Acute Lymphocytic Leukemia
• National Cancer Institute – Acute Lymphoblastic Leukemia
• Leukemia & Lymphoma Society – ALL Information
• NHS – Acute Lymphoblastic Leukaemia