Acute lymphoblastic leukemia (ALL), also called acute lymphocytic leukemia, is a fast-growing blood cancer. Many people with ALL experience health problems — both symptoms and signs — as a result of their condition. Symptoms are changes that you feel or experience but that other people may not know about. Signs are things that other people such as your doctor can see or measure. For example, a feeling of pain is a symptom but a rash is a sign.

The signs and symptoms of ALL can get worse quickly. Make sure to tell your doctor if you are experiencing any feeling or change that may be a symptom of leukemia. Your doctor can detect signs of leukemia using a physical exam and diagnostic tests.

Signs and Symptoms of ALL

In ALL, cancerous lymphocytes take over the bone marrow (tissue inside of bones where new blood cells are made). As a result, the bone marrow has a hard time producing more cells and levels of blood cells drop. People with ALL often have low levels of one or more types of blood cells, which prevents them from effectively doing their jobs:

• Red blood cells, which transport oxygen around the body
• Platelets, which clot the blood
• Healthy, noncancerous white blood cells, which fight infection

ALL also leads to high levels of abnormal, cancerous white blood cells. These leukemia cells can cause additional problems when they collect in the organs of the immune system or spread to other locations in the body. ALL signs like abnormal blood cell levels can each lead to their own sets of symptoms.

Anemia

Having low levels of red blood cells is known as anemia. When people with ALL develop anemia, they may experience symptoms such as:

• Tiredness
• Dizziness
• Shortness of breath
• Pale skin

Leukopenia

People with ALL may have leukopenia, or low levels of healthy white blood cells. Leukopenia often leads to infection. Symptoms of infection may include:

• Fever or chills
• Tiredness
• Coughing
• Sore throat
• Pain or burning sensation while urinating
• Shortness of breath
• Diarrhea

Thrombocytopenia

ALL sometimes causes low platelet counts, also known as thrombocytopenia. People with thrombocytopenia often bruise more easily than usual. They can also develop bleeding problems like:

• Nosebleeds
• Bleeding gums
• Menstrual period changes
• Petechiae (small red, purple, or brown spots caused by bleeding under the skin)

General Symptoms

Both childhood and adult acute lymphoblastic leukemia frequently lead to other general symptoms including:

• Fever
• Night sweats
• Loss of appetite
• Weight loss

Enlarged Spleen or Liver

When cancer cells build up inside of organs, the organs can swell. People with ALL may develop splenomegaly (enlarged spleen) or hepatomegaly (enlarged liver). These signs can cause symptoms like pain or swelling in the abdomen and feeling unusually full after eating.

Enlarged Lymph Nodes

Lymph nodes are glands that help filter germs and waste from the body. ALL cells can spread to the lymph nodes, leading to hard lumps in the neck, armpit, or groin. This sign is called lymphadenopathy.

Joint Pain

When large numbers of white blood cells collect inside the bones or joints, they can cause pain or swelling. This could feel like an aching pain or like a sharp, stabbing pain. In children with ALL, these may be misidentified as growing pains.

Enlarged Thymus

Certain subtypes of ALL can lead to different symptoms. T-cell ALL, which affects a type of white blood cell called T cells, can lead to problems with the thymus. An organ that sits behind the breastbone, the thymus is where T cells develop. When a person has too many cancerous T cells, the thymus can expand, causing symptoms like breathing problems or coughing. An enlarged thymus can also block a vein called the superior vena cava. Blocking this vein can lead to headaches, passing out, or swelling in the arms, neck, and face.

Thymus symptoms are not seen in people who have ALL that develops from B cells, called B-cell acute lymphoblastic leukemia.

Central Nervous System Symptoms

ALL sometimes spreads to the central nervous system (brain and spinal cord), which can lead to additional symptoms, such as:

• Headaches
• Dizziness
• Blurry vision
• Seizures

What To Do If You Experience ALL Symptoms

If you are experiencing any possible symptoms of leukemia, talk to your health care team. These symptoms are more often caused by other health conditions besides ALL, such as the flu. However, it’s important to let your doctor know whenever you notice changes to your health.

If your doctor thinks that you may have leukemia, they may suggest undergoing tests that can help confirm a diagnosis. Leukemia diagnosis often begins with blood tests such as a complete blood count, which measures the levels of each type of blood cell. Other tests may include imaging tests or a bone marrow biopsy.

ALL Treatment Side Effects

Many ALL treatments cause additional health problems. Chemotherapy drugs often cause side effects like nausea, vomiting, mouth sores, and hair loss. The side effects of targeted therapy drugs are often milder and can include nausea, vomiting, diarrhea, and swelling in the eyes or legs.

Managing Signs, Symptoms, and Side Effects of ALL

Palliative care is a specialized type of medical care that helps treat the symptoms and side effects of chronic illnesses. This type of care can be used at any stage of an illness, no matter what a person’s prognosis is. Palliative treatments can reduce leukemia symptoms, make other treatments easier to undergo, and improve quality of life.

Many palliative treatments for leukemia aim to reverse low levels of blood cells. People with ALL often need blood transfusions, for which they receive healthy red blood cells or platelets from a donor. People with ALL often don’t have enough white blood cells, so antibiotics are another common palliative treatment to prevent or treat infections. Other palliative care options can help lessen the side effects of cancer treatments.

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia and their loved ones. On MyLeukemiaTeam, more than 8,600 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Are you living with acute lymphoblastic leukemia? What were your initial symptoms? Share your experiences in the comments below, or start a conversation by posting on MyLeukemiaTeam.