10 Common Chronic Lymphocytic Leukemia Symptoms You Should Know

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the blood and bone marrow, specifically targeting a type of white blood cell called lymphocytes. CLL is one of the most common types of leukemia in adults, particularly affecting older individuals. Understanding the symptoms of CLL is crucial because this condition often develops slowly, and many people may not experience noticeable signs in the early stages. In fact, CLL is frequently discovered during routine blood tests before symptoms appear.

What is CLL? CLL leukemia occurs when the bone marrow produces too many abnormal lymphocytes that don’t function properly. These cancerous cells accumulate over time, crowding out healthy blood cells and compromising the immune system. Unlike acute leukemia, chronic leukemia progresses gradually, which is why recognizing the warning signs is essential for early detection and management.

This comprehensive guide will walk you through the most common chronic lymphocytic leukemia symptoms, helping you understand what to watch for and when to consult with a healthcare professional.

1. Swollen Lymph Nodes (Lymphadenopathy)

One of the most characteristic signs of CLL is enlarged lymph nodes, medically known as lymphadenopathy. These swollen nodes typically appear in the neck, armpits, or groin area and are usually painless to the touch.

The lymph nodes may feel like small, rubbery lumps under the skin and can range in size from a pea to a grape or larger. Unlike swollen lymph nodes caused by infections, which typically resolve within a few weeks, lymph nodes affected by CLL cancer tend to persist and may gradually increase in size over months or years.

Key characteristics:

• Painless lumps that don’t go away
• Most commonly found in the neck, underarms, and groin
• May occur on one or both sides of the body
• Gradually increase in size over time
• Nodes feel firm and mobile under the skin

2. Persistent Fatigue and Weakness

Extreme tiredness and weakness are among the most common chronic lymphocytic leukemia symptoms reported by patients. This fatigue goes beyond normal tiredness and doesn’t improve significantly with rest or sleep.

The fatigue associated with CLL occurs because the cancerous lymphocytes crowd out healthy red blood cells, leading to anemia. Red blood cells are responsible for carrying oxygen throughout the body, so when their numbers decrease, every organ and tissue receives less oxygen, resulting in profound exhaustion. Additionally, the body’s ongoing effort to fight the disease process itself contributes to energy depletion.

Patients often describe this fatigue as:

• Overwhelming tiredness that interferes with daily activities
• Difficulty completing routine tasks that were previously easy
• Need for frequent rest periods throughout the day
• Lack of energy even after a full night’s sleep
• Physical and mental exhaustion

3. Frequent Infections

People with CLL are significantly more susceptible to infections because the disease compromises the immune system. The abnormal lymphocytes produced in CLL don’t function properly, meaning they cannot effectively fight off bacteria, viruses, and other pathogens.

These infections may occur more frequently than normal and can be more severe or take longer to resolve. Common infections in CLL patients include respiratory tract infections (such as pneumonia, bronchitis, and sinusitis), urinary tract infections, and skin infections.

Warning signs include:

• Recurring colds, flu, or respiratory infections
• Infections that don’t respond well to standard treatment
• Prolonged recovery time from minor illnesses
• Unusual or opportunistic infections
• Fever that comes and goes without clear cause

4. Unintentional Weight Loss

Unexplained weight loss is another significant symptom of chronic leukemia. This is defined as losing 10% or more of your body weight over a period of six months without trying to lose weight through diet or exercise changes.

The weight loss occurs due to several factors related to CLL. The cancer cells consume a large amount of the body’s energy resources, increasing metabolic demands. Additionally, the disease can affect appetite and the body’s ability to absorb nutrients properly. Some patients may also experience early satiety (feeling full quickly) due to an enlarged spleen pressing on the stomach.

This symptom is particularly concerning because it indicates that the disease may be progressing and affecting the body’s normal metabolic processes.

5. Night Sweats

Severe night sweats, also called drenching night sweats, are a common CLL symptom that can significantly impact quality of life. These are not mild perspiration but rather profuse sweating episodes that can soak through nightclothes and bedding, often requiring you to change clothes or sheets during the night.

Night sweats in CLL are considered a “B symptom,” which indicates more active disease. They occur due to the body’s immune response to the cancer cells and the release of certain chemicals called cytokines that affect the body’s temperature regulation system.

Characteristics of CLL-related night sweats:

• Occur regularly, often several nights per week
• So severe that nightclothes and bedding become drenched
• Not related to room temperature or excess blankets
• May be accompanied by fever or chills
• Can disrupt sleep and contribute to fatigue

6. Enlarged Spleen (Splenomegaly) and Abdominal Discomfort

The spleen, an organ located in the upper left side of the abdomen, commonly becomes enlarged in people with CLL. This condition, known as splenomegaly, occurs because cancerous lymphocytes accumulate in the spleen, causing it to swell beyond its normal size.

An enlarged spleen can cause several noticeable symptoms. You may feel fullness or discomfort in the upper left abdomen, especially after eating small amounts of food. Some people can actually feel the enlarged spleen as a mass under the left rib cage. The enlarged spleen may also press on nearby organs, including the stomach, causing early satiety and contributing to weight loss.

Symptoms of an enlarged spleen include:

• Feeling of fullness or pressure in the left upper abdomen
• Pain or discomfort that may radiate to the left shoulder
• Inability to eat large meals (early satiety)
• Visible swelling in the abdominal area
• Discomfort when taking deep breaths

7. Easy Bruising and Bleeding

People with CLL often notice they bruise more easily than before, and bruises may appear larger than expected from minor bumps or injuries. They may also experience prolonged bleeding from small cuts or frequent nosebleeds and bleeding gums.

This symptom occurs because CLL affects the bone marrow’s ability to produce adequate platelets, the blood cells responsible for clotting. When platelet counts drop (a condition called thrombocytopenia), the blood cannot clot properly, leading to increased bruising and bleeding.

Signs to watch for:

• Bruises appearing without clear cause or from minimal trauma
• Bruises that are unusually large or take longer to heal
• Small red or purple spots on the skin (petechiae)
• Bleeding gums when brushing teeth
• Frequent or prolonged nosebleeds
• Heavy or prolonged menstrual periods in women

8. Fever Without Obvious Infection

Low-grade fever is a common symptom among CLL patients. These fevers typically remain below 100.4°F (38°C) and may come and go without an obvious source of infection. Unlike fevers caused by common illnesses, CLL-related fevers don’t typically respond to over-the-counter fever reducers and may persist for extended periods.

The fever occurs as part of the body’s immune response to the cancer cells. The presence of abnormal cells triggers the release of pyrogens, substances that signal the body to raise its temperature. Persistent or recurring fever without an identifiable infection should always be evaluated by a healthcare provider, especially in someone already diagnosed with CLL or who has other risk factors.

9. Shortness of Breath (Dyspnea)

Shortness of breath or difficulty breathing with minimal exertion is another important symptom of CLL leukemia. Patients may notice they become winded more easily when climbing stairs, walking short distances, or performing activities that previously didn’t cause breathlessness.

This symptom develops primarily due to anemia—the reduced number of red blood cells means less oxygen is delivered to the body’s tissues and organs. Additionally, if CLL causes enlargement of lymph nodes in the chest, these swollen nodes can press on airways or blood vessels, further contributing to breathing difficulties.

Patients may experience:

• Breathlessness with mild physical activity
• Feeling the need to rest frequently during activities
• Rapid breathing or increased respiratory rate
• Sensation of not getting enough air
• Difficulty lying flat (in severe cases)

10. Pale Skin (Pallor)

Paleness of the skin, mucous membranes, and nail beds is a visible sign of anemia commonly seen in people with CLL. The skin may appear noticeably paler than usual, particularly in the face, palms, and inside the lower eyelids.

This pallor occurs because anemia reduces the amount of oxygen-rich, red-colored hemoglobin in the blood that gives skin its normal color. The severity of pallor often corresponds to the degree of anemia. This symptom may develop gradually and might not be immediately obvious to the patient, but friends or family members may notice the change in complexion.

Areas where pallor is most noticeable:

• Face and lips
• Palms of hands
• Nail beds
• Inner surface of lower eyelids
• Tongue and mucous membranes inside the mouth

Main Causes of Chronic Lymphocytic Leukemia

While the exact cause of CLL remains unknown, researchers have identified several factors that may contribute to the development of this disease:

Genetic Mutations: CLL develops when DNA mutations occur in blood-producing cells in the bone marrow. These mutations cause the cells to produce abnormal lymphocytes that don’t die when they should and continue to multiply, crowding out healthy blood cells. The specific genetic changes that trigger these mutations are still being studied.

Age: Age is one of the most significant risk factors for CLL. The disease primarily affects older adults, with the majority of cases diagnosed in people over 60 years old. It is extremely rare in people under 40.

Family History: Having a first-degree relative (parent, sibling, or child) with CLL or other blood cancers increases your risk of developing the disease. This suggests a genetic component, although no single gene has been identified as the cause.

Ethnicity and Geography: CLL is more common in North America and Europe compared to Asian countries. People of European or Eastern European Jewish descent have a higher risk of developing CLL compared to Asian or African populations.

Gender: Men are approximately 1.5 to 2 times more likely to develop CLL than women, though the reasons for this gender difference are not fully understood.

Chemical Exposure: Some studies suggest that long-term exposure to certain herbicides and pesticides, including Agent Orange, may increase the risk of developing CLL, though more research is needed to confirm this connection.

Monoclonal B-cell Lymphocytosis (MBL): This condition, where there are slightly elevated levels of abnormal B lymphocytes in the blood, is considered a precursor to CLL. Not everyone with MBL develops CLL, but having this condition does increase risk.

Frequently Asked Questions

What is the difference between CLL and other types of leukemia?

CLL is a chronic (slow-growing) leukemia that specifically affects B lymphocytes, a type of white blood cell. Unlike acute leukemias, which progress rapidly and require immediate treatment, CLL typically develops slowly over years. Many patients with early-stage CLL don’t require immediate treatment and are monitored through a “watch and wait” approach. Other leukemias include acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML), each affecting different cell types and progressing at different rates.

Can CLL be detected through routine blood tests?

Yes, CLL is often first detected through routine blood tests, such as a complete blood count (CBC), before any symptoms appear. An elevated white blood cell count, particularly lymphocytes, may prompt further investigation. Many people are diagnosed with CLL incidentally during blood work performed for unrelated reasons. If CLL is suspected, additional tests including blood smears, flow cytometry, and genetic testing may be ordered to confirm the diagnosis.

Are CLL symptoms constant or do they come and go?

CLL symptoms can vary in their presentation. Some symptoms, like swollen lymph nodes and fatigue, tend to be persistent but may fluctuate in severity. Other symptoms, such as fever and night sweats, may come and go. Because CLL is a chronic condition that progresses slowly, symptoms often develop gradually over time rather than appearing suddenly. Some people remain asymptomatic for years, while others experience progressively worsening symptoms as the disease advances.

When should I see a doctor about potential CLL symptoms?

You should consult a healthcare provider if you experience persistent swollen lymph nodes (lasting more than two weeks), unexplained fatigue that doesn’t improve with rest, frequent infections, unintentional weight loss, or any combination of the symptoms described in this article. While these symptoms can be caused by many conditions other than CLL, it’s important to get them evaluated. If you have a family history of CLL or blood cancers, mention this to your doctor as it may warrant earlier or more thorough evaluation.

Is CLL curable?

CLL is generally considered a manageable but not curable disease with current standard treatments. However, medical advances continue to improve outcomes and quality of life for people with CLL. Many patients live for years or even decades after diagnosis. Some people with early-stage CLL never require treatment and maintain good quality of life through monitoring alone. For those who do require treatment, various therapeutic approaches can effectively control the disease, reduce symptoms, and extend survival. Recent advances in targeted therapies and immunotherapies have significantly improved the prognosis for CLL patients.

What medical tests are used to diagnose CLL?

Several tests are used to diagnose CLL. A complete blood count (CBC) measures different blood cell types and can reveal elevated white blood cells. Flow cytometry analyzes blood or bone marrow samples to identify specific markers on cell surfaces that confirm CLL. Bone marrow biopsy may be performed to examine how much of the marrow is affected by cancer cells. Genetic and molecular tests, including FISH (fluorescence in situ hybridization) and mutation analyses, help identify specific chromosomal abnormalities and mutations that can influence prognosis and treatment decisions. Imaging tests like CT scans may be used to assess lymph node and organ involvement.

Does having CLL symptoms mean the disease is advanced?

Not necessarily. While some symptoms do indicate more active disease, the presence of symptoms alone doesn’t always correlate with disease stage. Many people have enlarged lymph nodes or mild fatigue even in early-stage CLL. However, certain symptoms—called “B symptoms” in medical terminology—including significant weight loss, drenching night sweats, and persistent fever, may indicate more active or advanced disease. The staging of CLL is determined through a combination of physical examination findings, blood counts, and imaging studies rather than symptoms alone. Your healthcare provider will use standardized staging systems to assess disease extent and determine if treatment is needed.

References:

• American Cancer Society – Chronic Lymphocytic Leukemia
• Mayo Clinic – Chronic Lymphocytic Leukemia
• National Cancer Institute – Chronic Lymphocytic Leukemia Treatment
• Leukemia & Lymphoma Society – CLL Information
• NHS – Chronic Lymphocytic Leukaemia