Symptoms of Acute Lymphoblastic Leukemia (ALL)
Patients with ALL typically present with fatigue, constitutional symptoms (fevers, night sweats, weight loss), easy bruising or bleeding, recurrent infections, and bone/joint pain—particularly in children where musculoskeletal pain may be the sole presenting complaint. 1
Hematologic Manifestations
The most common symptoms arise from bone marrow infiltration causing cytopenias:
- Fatigue and lethargy result from anemia secondary to bone marrow failure and are among the most frequent presenting complaints 1, 2, 3
- Easy bruising or bleeding occurs due to thrombocytopenia and platelet dysfunction 1, 2, 3
- Recurrent infections develop from neutropenia and leukocyte dysfunction 1, 2, 3
- Dyspnea and dizziness relate directly to anemia 1, 3
Constitutional Symptoms
Musculoskeletal Symptoms
- Bone and joint pain is a critical presenting feature, especially in pediatric patients where it may be the only presenting symptom 1
Physical Examination Findings
- Lymphadenopathy is frequently detected on examination 1, 2
- Splenomegaly and/or hepatomegaly are present in approximately 20% of patients 1, 2
- Mediastinal mass from thymic involvement occurs particularly in T-cell ALL 1, 2
Neurologic Manifestations
- Chin numbness or facial palsy may result from cranial nerve or CNS involvement 1
Subtype-Specific Presentations
A critical pitfall: Abdominal masses from gastrointestinal involvement are more suggestive of mature B-cell ALL (Burkitt lymphoma) rather than typical precursor B-cell ALL 1. This distinction is important because mature B-cell ALL requires different treatment approaches.
Clinical Context
The presentation is typically nonspecific, which can delay diagnosis 1. The NCCN emphasizes that symptoms develop from infiltration of blasts in the bone marrow, lymphoid system, and extramedullary sites including the CNS and testicles 1, 2.
Important caveat: In cases of hyperleukocytosis (≥100,000 leukocytes per microliter), patients may present acutely with symptoms related to leukostasis, making bone marrow aspiration potentially hazardous; peripheral blood can substitute for diagnosis in these situations 1.