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Diagnosis and tests

Symptoms of CLL

The related article (“CLL: symptoms, diagnosis and staging”) explains bone marrow biopsy. This topic looks closely at the symptoms of chronic lymphocytic leukaemia (CLL): its often silent start, and the signs that point to a need for treatment.

Last updated: ~1 min read
A body with highlighted nodes.
Figure 1.Painless lymph nodes.

01Short answer

CLL is a leukaemia seen mostly in older people, and it develops very slowly. Many people have no symptoms, and it is found because of raised lymphocytes on an ordinary blood test. When there are symptoms, they include painless enlarged lymph nodes in the neck, armpits and groin; heaviness under the left ribs from the spleen; tiredness; and frequent repeated infections (pneumonia, sinusitis, shingles) because antibodies are low. “B symptoms” (night sweats, unexplained fever and weight loss) can point to more active disease. Sometimes the immune system attacks the body’s own red cells or platelets (autoimmune haemolytic anaemia, thrombocytopenia). Many people live for years with monitoring alone.

02Simple explanation

Often no symptoms.

Painless nodes and infections.

B symptoms: a sign of activity.

03Scientific explanation

Reasons to treat: worsening cytopenias, large or troublesome nodes or spleen, marked B symptoms and a fast-rising lymphocyte count influence the decision to treat; a high count alone is not enough.

Autoimmunity: autoimmune haemolytic anaemia and immune thrombocytopenia are more common in CLL.

04What happens in the body?

Painless nodes

Soft, painless swellings in the neck, armpits and groin.

B symptoms

Night sweats, fever and weight loss need attention.

A damp pillow and a thermometer.
Figure 2.B symptoms — Symptoms of CLL

Active monitoring

Many people live for years with regular check-ups.

A calendar with regular marks.
Figure 3.Active monitoring — Symptoms of CLL

05How CLL shows up

Four steps.

Test — Many lymphocytes.1TestMany lymphocytes.
Nodes — Painless swellings.2NodesPainless swellings.
Monitoring — Regular checks.3MonitoringRegular checks.
Signals — Report them.4SignalsReport them.

06Symptom and meaning

SymptomWhat it may mean
Painless nodesLymphocytes collecting
Repeated infectionsLow antibodies
Night sweats, weight lossActive disease
Tiredness, palenessAnaemia, sometimes autoimmune
BruisingLow platelets

07Key terms

CLL
Chronic lymphocytic leukaemia.
Lymphocytosis
Too many lymphocytes in the blood.
B symptoms
Sweats, fever, weight loss.
Active monitoring
Regular checks without treatment.
Autoimmune
The immune system attacking the body’s own cells.

08Key points

  • CLL often causes no symptoms.
  • Painless nodes may occur.
  • Infections are common.
  • B symptoms signal activity.
  • Many people are only monitored.
  • Report new symptoms.

09Frequently asked questions

I am not being treated; is that normal?

Yes, in early stages active monitoring is the standard approach.

My nodes are growing; what should I do?

Mention it at your next visit, or at once if they grow quickly.

How can I protect myself from infection?

Vaccines and hygiene; sometimes immunoglobulin (“Antigens and antibodies”).

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. I am not being treated; is that normal?

  2. My nodes are growing; what should I do?

  3. How can I protect myself from infection?

My questions

12Sources

  1. National Cancer Institute (NCI). CLL treatment (PDQ), patient version
  2. MedlinePlus (U.S. National Library of Medicine). White Blood Count (WBC)
  3. American Cancer Society. Infections in People with Cancer
  4. NHS. Acute lymphoblastic leukaemia — Tests and next steps
  5. Annals of Oncology (ESMO), 2016. Acute lymphoblastic leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
  6. The Lancet, 2020. Acute lymphoblastic leukaemia (review)
  7. Blood Cancer United (formerly The Leukemia & Lymphoma Society). Acute promyelocytic leukemia (APL)
  8. Blood (American Society of Hematology), 2011. Early death rate in acute promyelocytic leukemia remains high despite all-trans retinoic acid
  9. Leukemia (Nature), 2011. Continuing high early death rate in acute promyelocytic leukemia: a population-based report from the Swedish Adult Acute Leukemia Registry
  10. American Cancer Society. Signs and Symptoms of Chronic Myeloid Leukemia
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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