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Acute lymphocytic leukemiaAcute lymphoblastic (or lymphocytic) leukemia
Acute Lymphocytic Leukemia (ALL)
There are four major types of leukemia. ALL is the most common in children, and the least common in adults. About 6,000 people are diagnosed with ALL each year. Children account for two-thirds of these cases. In general, children with ALL have a betteroutlook than adults. Most children with ALL can be cured of this cancer.
Symptoms and Diagnosis
Symptoms of ALL include fatigue, pale skin, recurrent infections, bone pain, bruising, and small red spots under the skin. Doctors use various tests, including blood counts and bone marrow biopsies, to diagnose ALL.
ALL is treated with chemotherapy and, sometimes, radiation. Children receive different chemotherapy regimens than adults. Some patients with advanced cancer that has not responded to these treatments may need a stem cell transplant.
Infection Prevention
Both chemotherapy and transplantation increase the risk for infection. Patients must take strict precautions to avoid exposure to germs. Ways to prevent infection include:
- Practice good hygiene including regular handwashing and dental care (such as brushing and flossing).
- Avoid crowds, especially during cold and flu season.
- Eat only well-cooked foods (no raw fruits or vegetables or undercooked poultry, meat, or fish).
- Boil tap water before drinking it.
- Do not keep fresh flowers or plants in your house as they may carry mold.
- Make sure you are up to date with vaccinations. Patients may benefit from repeat or booster immunizations.
New Drug Approvals
In 2012, the FDA approved two new drugs for treatment of adults with relapsed or refractory ALL:
- Ponatinib (Iclusig) is the newest tyrosine kinase inhibitor (TKI) drug approved for patients with Philadelphia chromosome-positive ALL. Ponatinib is approved for patients who have not been helped by other TKI drugs such as imatinib or dasatinib. It is a pill taken once a day.
- Marqibo is a specially-formulated type of vincristine (a standard cancer drug) that is approved for patients with Philadelphia chromosome-negative ALL. It is given asweekly injections.
The word leukemia literally means "white blood" and is used to describe a variety of cancers that begin in the blood-forming cells (lymphocytes) of the bone marrow.
Leukemias are divided into two major types:
- Acute (which progresses quickly with many immature white cells)
- Chronic (which progresses more slowly and has more mature white cells)
Both leukemia and lymphomas (Hodgkin's disease and non-Hodgkin's lymphomas) are cancers of lymphocytes. The difference is that leukemia starts in the bone marrow while lymphomas originate in lymph nodes and then spread to the bone marrow or other organs.
White blood cells (leukocytes) evolve from immature cells referred to as blasts. Malignancy of these blast cells is the source of leukemias, which generally progress as follows:
- Normally, blasts constitute 5% or less of healthy bone marrow. In leukemia, however, these blasts remain immature and multiply continuously but fail to mature properly, eventually constituting between 30 - 100% of the bone marrow.
- In time,these malignant blast cells fill up the bone marrow and prevent production of healthy red cells, platelets, and mature white cells (leukocytes).
Malignant blasts spill out of the marrow into the bloodstream and lymph system and can travel to the brain and spinal cord (the central nervous system). Some blasts are called lymphoblasts (which normally become mature cells called lymphocytes) and others are called myeloblasts (which mature to myeloid cells).
Acute leukemias subdivided into two classifications according to whether the malignant blasts are lymphocytes or myeloid:
- Acute lymphocytic leukemia (ALL), which is the subject of this report
- Acute myeloid leukemia (AML), which is not covered in this report
Acute Lymphocytic Leukemia
Acute lymphocytic leukemia (ALL) is also known as acute lymphoid leukemia or acute lymphoblastic leukemia. The majority of childhood leukemias are of the ALL type.
Lymphocytes are the body's primary immune cells. Among other vital functions, lymphocytes produce antibodies, factors that can target and attack specific foreign substances (antigens) and fight infections.
Lymphocytes develop in the thymus gland or bone marrow and are therefore categorized as either B cells (bone marrow-derived cells) or T cells (thymus gland-derived cells). ALL can arise from eitherT-cell or B-cell lymphocytes. Most cases of ALL involve B cells.
Doctors do not know exactly what causes acute lymphocytic leukemia (ALL). It is likely that ALL develops from a combination of genetic, biologic, and environmental factors.
Genetic Translocations
Up to 65% of leukemias contain genetic rearrangements, called translocations, in which some of the genetic material (genes) on a chromosome may be shuffled or swapped between a pair of chromosomes.
- The most common genetic translocation in ALL is the Philadelphia (Ph) chromosome where DNA is swapped between chromosomes 9 and 22 [t(9:22)]. It occurs in about 20 - 30% of adults and 3 - 5% of children with ALL.
- Another common translocation in ALL is t(12;21), which is referred to as TEL-AML1 fusion. It occurs in about 20% of patients with ALL.
Risk Factors
Acute lymphocytic leukemia is diagnosed in about 6,000 Americans each year. Children account for two-thirds of these new cases.
ALL in Children. ALL is the most common type of cancer diagnosed in children. ALL accounts for about 75% of cases of childhood leukemia. Each year, about 3,500 American children and adolescents are diagnosed with ALL. ALL can strike children of all ages, but itis most likely to occur before age 5 years. It is slightly more common in boys than in girls.
ALL in Adults. ALL is the least common type of leukemia among adults. About 1 in 3 cases of ALL occur in adults. Adults over age 50 have a higher risk for ALL than those between the ages of 20 - 50.
Race and Ethnicity
Caucasian and Hispanic children have a higher risk for ALL than African-American children.
Hereditary Disorders
ALL does not appear to run in families.Still, certain genetic disorders may increase risk. For example, children with Down syndrome have a 20-times greater risk of developing ALL than the general population. Other rare genetic disorders associated with increased risk include Klinefelter syndrome, Bloom syndrome, Fanconi anemia, ataxia-telangiectasia, neurofibromatosis, Shwachman syndrome, IgA deficiency, and congenital X-linked agammaglobulinemia.
Radiation and Chemical Exposure
Previous cancer treatment with high doses of radiation or chemotherapy can increase the risk for developing ALL. Prenatal exposure to x-rays may also increase risk in children. Lower levels of radiation (living near power lines, video screen emissions, small appliances, cell phones) are unlikely to pose any cancer risk.
The symptoms of ALL may be difficult to recognize. ALL usually begins abruptly and intensely, but in some cases symptoms may develop slowly. They may be present one day, and absent the next, particularly in children. Symptoms develop when:
- There are not enough healthy mature white blood cells (leukocytes) to mount a defense against infection.
- There are not enough healthy blood-clotting cells (platelets) to prevent bleeding.
- The depleted oxygen-bearing red blood cells can't provide enough oxygen to organs.
Symptoms include:
- Fatigue
- Paleness -- patients may have poor coloring from anemia caused by insufficient red blood cells
- Recurrent minor infections
- Fever without known cause
- Bone pain
- Abdominal swelling
- Bruising -- may result from only slight injury
- Poor healing of minor cuts
- Uncontrolled bleeding -- bleeding events increase as the bone marrow fails to produce enough platelets to make a normal blood clot, a condition called thrombocytopenia.
- Small, red spots on the skin (petechiae)
- Vision changes (rare)
ALL is diagnosed based on various tests.
Physical Examination
The doctor will examine a patient for signs of enlarged lymph nodes or enlarged liver or spleen. The doctor will also look for any signs of bruising or bleeding.
Blood Tests
A complete blood cell count (CBC), which checks for numbers of white cells, red blood cells, and platelets, is the first step in diagnosing ALL. Patients with ALL generally have a higher than normal white blood count and lower than normal red blood cell and platelet counts.
Blood tests are also performed to evaluate liver, kidney, and blood clotting status and to check for levels of certain minerals and proteins.
Bone Marrow Biopsy
If blood test results are abnormal or the doctor suspects leukemia despite normal cell counts, a bone marrow aspiration and biopsy are the next steps. These are very common and safe procedures. However, because this test can produce considerable anxiety, particularly in children, parents may want to ask the doctor if sedation is appropriate for their child.
- A local anesthetic is given.
- A needle is inserted into the bone, usually the rear hipbone. There may be brief pressure or pain. A small amount of marrow is withdrawn. Marrow looks like blood.
- A larger needle is then inserted into the same place and pushed down to the bone. The doctor will rotate the needle to obtain a specimen for the biopsy. The patient will feel some pressure.
- The sample is then taken to the lab to be analyzed. All the results are completed within a couple of days.
Normal bone marrow contains 5% or less of blast cells (the immature cells that ordinarily develop into healthy blood cells). In leukemia, abnormal blasts constitute between 30 - 100% of the marrow.
Spinal Tap
If bone marrow examination confirms ALL, a spinal tap (lumbar puncture) may be performed, which uses a needle inserted into the spinal canal. The patient feels some pressure and usually must lie flat for about an hour afterward to prevent severe headache. This can be difficult, particularly for children, so parents should plan reading or other quiet activities that will divert the child during that time. Parents should also be certain that the doctor performing this test is experienced in this procedure.
A sample of cerebrospinal fluid with leukemia cells is a sign that the disease has spread to the central nervous system. In most cases of childhood ALL, leukemia cells are not found in the cerebrospinal fluid.
Tests Performed after Diagnosis
Once a diagnosis of leukemia has been made, further tests are performed on the bone marrow cells:
- Cytochemistry, flow cytometry, immunocytochemistry, and immunophenotyping tests are used to to identify and classify specific types of leukemia. For example, cytochemistry distinguishes lymphocytic leukemia cells from myeloid leukemia cells. Immunophenotyping shows if ALL cells are T cells or B cells based on the antigen located on the surface of the cell.
- Cytogenetics and fluorescent in situ hybridization (FISH) are used for genetic analysis. Cytogenetic testing can detect translocations (such as Philadelphia chromosome) and other genetic abnormalities. FISH is used to identify specific changes within chromosomes. Genetic variations may help determine response to treatment.
Cell Classification
The results of cytogenetic, flow cytometry, immunophenotyping, and other tests can help provide information on types and subtypes of ALL cells. The particular subtype of cell can aid in determining prognosis and treatment.
An older classification system called the French-American-British (FAB) classification grouped ALL into L1, L2, and L3 subtypes. A newer classification system classifies ALL B cells or T cells based on their stage of maturity.
B-Cell ALL Subtype Classification:
- Early Pre-B
- Common ALL
- Pre-B ALL
- Mature B-cell ALL (Also called Burkitt leukemia)
T-Cell ALL Subtype Classification:
- Pre-T ALL
- Mature T-cell ALL
Acute lymphocytic leukemia is responsible for about 1,400 deaths a year in the U.S., and it can progress quickly if untreated. However, ALL is one of the most curable cancers and survival rates are now at an all-time high.
According to the American Cancer Society, certain factors can help determine prognosis:
- Age. Children have a better chance for recovery than adult patients. More than 95% of children with ALL attain remission. Among adults, younger patients (especially those younger than age 50) have a better prognosis than older patients.
- Initial white blood cell (WBC) count. People diagnosed with a WBC count below 50,000 tend to do better than people with higher WBC counts.
- ALL subtype. The subtype of T cell or B cell affects prognosis. For example, patients with T-cell ALL tend to have a better prognosis than those with mature B-cell ALL (Burkitt leukemia).
- Chromosome translocations. People who have Philadelphia chromosome-positive ALL tend to have a poorer prognosis, although new treatments are helping many of these patients achieve remission.
- Response to chemotherapy. Patients who achieve complete remission (absence of active cancer) within 4 - 5 weeks of starting treatment tend to have a better prognosis than those who take longer. Patients who do not achieve remission at any time have a poor prognosis. Evidence of minimal residual disease (presence of leukemia cells in the bone marrow) may also affect prognosis.
Other factors, such as central nervous system involvement or recurrence, may indicate a poorer prognosis.
Treatment Phases
There are typically three treatment stages for the average-risk patient with ALL:
- Induction therapy is given in order to achieve a first remission (the absence of active cancer)
- Consolidation (intensification) therapy is given to prevent relapse after remission has been achieved
- Maintenance treatment is lower intensity therapy given for several years to prevent relapse after remission
Because leukemia can also spread to the brain and spinal cord, where chemotherapy that is given intravenously or orally does not penetrate very well, most patients also need radiation to the brain and spinal cord, or chemotherapy that is injected into the layers around them. This is called central nervous system prophylaxis (preventive treatment) and is given during all treatment phases to prevent the cancer from spreading to the brain and spinal cord.
Specific Treatments Used in ALL
The following are specific treatments used for ALL:
- Chemotherapy is the primary treatment for each stage. Newer drugs known as biological therapies are also being used.
- Radiation to the brain and spinal cord is also administered in some cases.
- A bone marrow transplant may be recommended for some adult patients after treatment when there is no active cancer (remission) or for adults and children if the cancer has returned after treatment (relapsed).
Treatment to Achieve Remission (Induction Therapy)
The aim of induction therapy, the first treatment phase, is to reduce the number of leukemia cells to undetectable levels. The general guidelines for induction therapy are as follows:
- Patients are given intensive chemotherapy that uses powerful multi-drug regimens. (Infants require special regimens not discussed here.)
- For both children and adults, some of these therapies are administered orally, others intravenously.
- Hospitalization is usually necessary at some point to help prevent infection and to give transfusions of blood, platelets, and other blood products. However, much of this therapy can be given on an outpatient basis.
- After the first cycle of induction, bone marrow tests are done to determine if the patient is in remission.
- Another bone marrow test is sometimes performed about a week later to confirm the first results.
- A bone marrow transplant is considered for select patients who do not respond to induction treatment.
Drugs Used for Induction Chemotherapy
Both children and adults typically start with a 3-drug regimen. Imatinib (Gleevec) or dasatinib (Sprycel) may be added for patients with Philadelphia chromosome-positive ALL.
For children, the standard drugs are:
- Vincristine (Oncovin), a vinca alkaloid drug
- Prednisone or dexamethasone. These drugs are corticosteroids.
- Asparaginase. It is generally provided as pegaspargase (Oncaspar)rather thanL-asparaginase (Elspar) for treating newly diagnosed ALL in children.
For adults, the standard drugs are:
- Vincristine
- Prednisone
- Anthracycline drug, such as such as doxorubicin, daunorubicin, or epirubicin. Some adult chemotherapy regimens also add on an asparaginase drug or cyclophosphamide (Cytoxan).
Preventing Central Nervous System Disease (CNS Prophylaxis)
Chemotherapy given intravenously or orally does not penetrate the blood-brain barrier sufficiently to destroy leukemic cells in the brain. Since the brain is one of the first sites for relapsing leukemia, preventive treatment is administered to the brain, spine, and testes (called sanctuary disease sites). This is called CNS prophylaxis.
For children, CNS prophylaxis uses intrathecal chemotherapy, in which a drug is injected directly into the spinal fluid. Intrathecal chemotherapy is given with methotrexate alone or a combination of methotrexate (MTX), cytarabine, and hydrocortisone.
Some high-risk children may receive radiation to the skull (cranial radiation), radiation to the spine, or both along with intrathecal chemotherapy. This combination can be very toxic and is generally used only in children who have evidence of the disease in the central nervous system at the time of diagnosis. Long-term complications of high-dose cranial radiation can include learning and neurologic problems. Cranial radiation is also associated with increased risks for stroke and secondary cancers.
Adult CNS prophylaxis is performed in one of three ways:
- Cranial radiation plus intrathecal chemotherapy with methotrexate
- High-dose systemic infusion of methotrexate plus intrathecal methotrexate without cranial radiation
- Intrathecal methotrexate chemotherapy alone
Evidence of Remission after Induction Treatment
Survival in acute leukemia depends on complete remission (no signs of active cancer). Although not always clear-cut, remission is indicated by the following:
- All signs and symptoms of leukemia disappear.
- There are no abnormal cells in the blood, bone marrow, and cerebrospinal fluid.
- The percentage of blast cells in the bone marrow is less than 5%.
- Blood platelet count returns to normal.
Induction can produce extremely rapid results. Nearly all children with ALL achieve remission after a month of induction treatment. The shorter the time to remission the better the outlook:
- A complete remission usually occurs within the first 4 weeks. Patients who show low disease levels within 7 - 14 days have an excellent outlook, particularly if they have favorable genetic factors, and may need less-intensive treatments afterward.
- Patients with high disease levels at 14 days or who require more than 4 weeks to achieve remission are at higher risk for relapse and most likely need more aggressive treatment.
Side Effects and Complications
Side effects and complications of any chemotherapeutic regimen and radiation therapy are common, are more severe with higher doses, and increase over the course of treatment. Administering drugs for shorter duration can sometimes reduce toxicities without affecting the drugs' cancer-killing effects.
Common Side Effects. Typical side effects include:
- Nausea and vomiting. Drugs known as serotonin antagonists, such as ondansetron (Zofran) or granisteron (Kyril), can relieve these side effects.
- Diarrhea
- Hair loss
- Mouth sores
- Weight loss
- Depression
Serious Side Effects. Serious side effects can also occur and may vary depending on the specific drugs used.
Infection from suppression of the immune system or from severe drops in white blood cells is a common and serious side effect. Patients should make all efforts to prevent infection. The patient at high risk for infection may need potent antibiotics and antifungal medications as well as granulocyte colony-stimulating factors or G-CSF (lenograstim, filgrastim) to stimulate the growth of infection-fighting white blood cells. Patients should make all efforts to minimize exposure to bacteria and viruses. (See "Preventing Infection" in the Home Management section of this report.)
Other serious side effects include:
- Liver and kidney damage
- Immediate and short-term risks of radiation therapy may include seizures, stroke, and paralysis
- Very high levels of uric acid in the blood, which can damage the kidneys
- Very high levels of calcium in the blood, which can impair heart function
- Abnormal blood clotting
- Allergic reaction
- Low blood sugar (hypoglycemia) -- a rare complication in young, thin children who are taking purine analogues such as mercaptopurine and thioguanine
- Suppression of adrenal glands in children who take short-term, high-dose corticosteroids such as prednisolone
- Dasatinib can increase the risk of increased pressure in the arteries of the lungs (pulmonary arterial hypertension)
Long-Term Complications.
- Fatigue is very common after chemotherapy and can be significant and long-lasting.
- Combinations of intrathecal chemotherapy plus brain radiation in children can cause some serious complications, including seizures and problems in learning and concentration.
- Delayed puberty. The effects of treatment in the brain can affect regions that regulate reproductive hormones, which may affect fertility later on. Chemotherapy, cranial radiation, or both can impair fertility in male and female patients. Cranial radiation can also result in impaired growth.
- Bone density loss can occur after chemotherapy, particularly with corticosteroids and after bone marrow transplantation.
- Heart damage. Some of the treatments increase risk factors for future heart disease, including unhealthy cholesterol levels and high blood pressure. Patients treated for ALL should be regularly monitored for heart risks.
- Stroke. Survivors of childhood leukemia are at increased risk of later stroke, especially if they received treatment with cranial radiation.
- Secondary Cancers. Survivors of childhood ALL are at increased risk of later developing other types of cancers, including brain and spinal cord tumors, basal cell skin carcinoma, and myeloid (bone marrow) malignancies. Radiation and older types of chemotherapy are mainly responsible for this risk. Newer types of ALL treatment may be less likely to cause secondary cancers.
Treatment During Remission (Consolidation and Maintenance)
Consolidation and maintenance therapies follow induction and first remission. The goal of consolidation and maintenance therapies is to prevent a relapse.
Consolidation (Intensification) Therapy
Because there is a high risk of the cancer returning (relapsing) after the first phase of treatment (induction therapy), an additional course of treatment is given next. This is called consolidation therapy (also called intensification therapy). Consolidation is an intense chemotherapy regimen that is designed to prevent a relapse and usually continues for about 4 - 8 months.
Examples of consolidation regimens forpatients at standard risk:
- A limited number of courses of intermediate- or high-dose methotrexate
- An anthracycline drug, such as daunorubicin (Cerubidine), used for reinduction followed by cyclophosphamide (Cytoxan, Neosar) 3 months after remission
- Extended use of an asparaginase drug.
More intense regimens are used forpatients at high-risk for relapse.
The last phase of treatment is maintenance (also called continuation therapy):
- Maintenance therapy typically uses weekly administration of methotrexate (usually in oral form) and daily doses of mercaptopurine.
- If CNS prophylaxis was not givenbefore, it may be given now.
- Vincristine and a corticosteroid drug (generally dexamethasone) may be added to standard maintenance therapy.
A maintenance regimen is usually less toxic and easier to tolerate than induction and consolidation. Maintenance treatment lasts for about 2 - 3 years for most patients with ALL. It is not clear if maintenance therapy benefits patients who have certain specific types of ALL, such as T-cell ALL or mature B-cell ALL (Burkitt leukemia).
Treatment After Relapse
Relapse is when cancer returns after remission. Most patients with ALL achieve remission after induction therapy, but in some patients the disease returns.
The following are factors that increase the risk for relapse after initial treatments:
- Microscopic evidence of leukemia after 20 weeks of therapy (minimal disease)
- Age over 30
- A high white blood cell count at the time of diagnosis
- Disease that has spread beyond the bone marrow to other organs
- Certain genetic abnormalities, such as the presence of the Philadelphia chromosome or MLL gene translocations
- Patients with high disease levels after 7 - 14 days of induction therapy
- The need for 4 or more weeks of induction chemotherapy in order to achieve a first complete remission.
Treatment for relapse after a first remission may be standard chemotherapy or experimental drugs, or more aggressive treatments such as stem cell transplants.
The decision depends on a number of factors including how soon relapse occurs after treatment:
- Children who relapse 3 or more years after achieving a first complete remission usually achieve a second remission with a second round of standard chemotherapy treatments.
- Children who relapse within 6 months to 3 years following treatment may be able to achieve remission with a more aggressive course of chemotherapy.
- Children who relapseless than 6 months following initial treatment, or while on chemotherapy have a lower chance for a second remission. In such cases, stem cell transplantation may be considered. Stem cell transplantation is especially considered for children who relapse with T-cell ALL.
- Adult patients with ALL who experience a relapse following maintenance therapy are unlikely to be helped by additional chemotherapy alone. They are considered candidates for stem cell transplantation. Stem cell transplantation is also an option for adults, but not children, who have achieved a first remission.
Transplantation procedures are reserved for patients with high-risk disease who are unlikely to achieve remission with chemotherapy alone. Transplantation does not offer any additional advantages for patients at low or standard risk.
Chemotherapy Drugs Used After Relapse
Many different drugs are used to treat ALL relapses. These drugs include vincristine, asparaginase, anthracyclines (doxorubicin, daunorubicin), cyclophosphamide, cytarabine (ara-C), and epipodophyllotoxins (etoposide, teniposide). In 2012, the FDA approved Marqibo, a specially-formulated type of vincristine injection, for adults with Philadelphia chromosome-negative ALL. Other drugs for relapsed or refractory ALL include nelarabine (Arranon), for T-cell ALL, and clofarabine (Clolar). Corticosteroids, such as prednisone or dexamethasone, may also be used.
The most recently approved treatments for ALL are biologic drugs that are tyrosine kinase inhibitors (TKIs). Tyrosine kinase is a growth-stimulating protein. TKI drugs block the cell signals that trigger cancer growth. TKI drugs approved for adult patients with Philadelphia chromosome-positive (Ph+) ALL include:
- Imatinib (Gleevec) is approved for adults with Ph+ ALL that has not responded to or has returned after treatment
- Dasatinib (Sprycel) is approved for adult patients with Ph+ ALL who were not helped by imatinib or other treatments
- Ponatinib (Iclusig) is approved for adults with Ph+ ALL that has not responded to prior treatment with another tyrosine kinase inhibitor drug such as imatinib or dasatinib
Stem cells that are made in the bone marrow are the early form of all blood cells in the body. They normally mature into red, white, or immune cells. To help the patient survive high dose chemotherapy needed to cure leukemia that has returned treatment, or not responded to treatment, a stem cell transplantation procedure may be used. Stem cell transplantation replaces blood stem cells that were lost during the initial chemotherapy treatment. The lost stem cells are replaced by transplanting them from a donor into the patient.
Types of Donors
The stem cells to be given to the person with leukemia can come from either the patient (autologous) or a donor(allogeneic):
- Allogeneic transplant. In an allogeneic transplant, the stem cells are taken from another person or donor. The immune system of the person receiving the new cells will usually try to reject these new, foreign cells. The more similar genetically the donor cells are, however, the less likely the person receiving the cells will reject them. Allogeneic transplants that are from genetically matched sibling donors offer the best results in ALL. With new techniques, donor bone marrow from unrelated but immunologically similar donors is proving to work as well as those from matched siblings
- Autologous transplant. If the marrow or blood cells used are the patient's own, the transplant is called autologous. Autologous transplants in patients with ALL are generally not beneficial, since there is some danger that the cells used may contain tumor cells and the cancer can regrow. Treatment advances that reduce this risk, however, may make autologous transplantation feasible in patients without family donors.
The Blood Stem Cell Collection Procedure
Sources of Cells. Stem cells can be obtained either from the donor's:
- Bone marrow (bone marrow transplantation)
- Blood (peripheral blood stem cell transplantation)
The Transplant Procedure
- The patient with ALL is given high-dose chemotherapy with or without radiation -- a treatment known as conditioning. The point is to inactivate the immune system and to kill any remaining leukemia cells.
- A few days after treatment, the patient is rescued using the stored stem cells, which are administered through a vein. This may take several hours. Patients may experience fever, chills, hives, shortness of breath, or a fall in blood pressure during the procedure.
- The patient is kept in a protected environment to minimize infection, and the patient usually needs blood cell replacement and nutritional support.
Side Effects and Complications
Stem-cell transplantation is a serious and complex procedure that can cause many short- and long-term side effects and complications. Early side effects of transplantation are similar to chemotherapy and include nausea, vomiting, fatigue, mouth sores, and loss of appetite. Bleeding because of reduced platelets is a high risk during the first four weeks and may require transfusions. Later side effects include fertility problems (if the ovaries are affected), thyroid gland problems (which can affect metabolism), lung damage (which can cause breathing problems) and bone damage.
Two of the most serious complications of transplantation are infection and graft-versus-host disease:
Infection resulting from a weakened immune system is the most common danger. The risk for infection is most critical during the first 6 weeks following the transplant, but it takes 6 - 12 months post-transplant for a patient's immune system to fully recover. Many patients develop severe herpes zoster virus infections (shingles) or have a recurrence of herpes simplex virus infections (cold sores and genital herpes). Pneumonia and infections with germs that normally do not cause serious infections such as cytomegalovirus, aspergillus (a type of fungus), and Pneumocystis jerovicii (a fungus) are among the most serious life-threatening infections.
It is very important that patients take precautions to avoid post-transplant infections. (See Home Management section of this report.)
Graft-versus-host disease (GVHD) is a serious attack by the patient's immune system triggered by the donated new marrow in allogeneic transplants.
Acute GVHD occurs in 30 - 50% of allogeneic transplants, usually within 25 days. Its severity ranges from very mild symptoms to a life-threatening condition (more often in older patients). The first sign of acute GVHD is a rash, which typically develops on the palms of hands and soles of feet and can then spread to the rest of the body. Other symptoms may include nausea, vomiting, stomach cramps, diarrhea, loss of appetite and jaundice (yellowing of skin and eyes). To prevent acute GVHD, doctors give patients immune-suppressing drugs such as steroids, methotrexate, cyclosporine, tacrolimus, and monoclonal antibodies.
Chronic GVHD can develop 70 - 400 days after the allogeneic transplant. Initial symptoms include those of acute GVHD. Skin, eyes, and mouth can become dry and irritated, and mouth sores may develop. Chronic GVHD can also sometimes affect the esophagus, gastrointestinal tract and liver. Bacterial infections and chronic low-grade fever are common. Chronic GVHD is treated with similar medicines as acute GVHD.
Too much sun exposure can trigger GVHD. Be sure to always wear sunscreen (SPF 15 or higher) on areas of the skin that are exposed to the sun. Stay in the shade when you go outside.
Home Management
A parent should call the doctor if the child has any symptoms that are out of the ordinary, including (but not limited) to:
- Any fever of 101 °F or higher
- Any signs of a flu or cold
- Shortness of breath
- Severe diarrhea
- Blood in the urine or stools
- Trouble urinating
Tracking Neutrophils. Parents should track their child's absolute neutrophil count. This measurement for the amount of white blood cells is an important gauge of a child's ability to fight infection.
- Counts over 1,000 usually provide sufficient protection so that children can engage in normal activities, including school and other functions where they are exposed to other children.
- If the count is between 500 - 1,000, the child should avoid large groups.
- If it falls between 200 - 500, the child should stay at home and should see only healthy visitors who have washed their hands vigorously.
- Neutrophil counts below 200 indicate that the child is at high risk for infection and should have no visitors.
Preventing Infection
It is very important to take precautions to prevent infection following chemotherapy or transplantation. Guidelines for infection prevention and control include:
- Discuss with the doctor what vaccinations are needed and when. Children with ALL may need reimmunization. In general, it is best to have immunizations prior to chemotherapy and to avoid live virus vaccines during treatment,
- Avoid crowds, especially during cold and flu season.
- Be diligent about hand washing and make sure that visitors wash their hands. Alcohol-based handrubs are best.
- Avoid eating raw fruits and vegetables. Poultry, meat, fish, eggs and other foods should be cooked thoroughly. Do not eat foods purchased at salad bars or buffets. In the first few months after the transplant, be sure to eat protein-rich foods to help restore muscle mass and repair cell damage caused by chemotherapy and radiation.
- Boil tap water before drinking it.
- Dental hygiene is very important, including daily brushing and flossing. Use a soft toothbrush to prevent gum bleeding. Schedule regular visits with your dentist.
- Do not sleep with pets. Avoid contact with pets' excrement.
- Avoid fresh flowers and plants as they may carry mold. Do not garden.
- Swimming may increase exposure to infection. If you swim, do not submerge your face in water. Do not use hot tubs.
- Report to the doctor any symptoms of fever, chills, cough, difficulty breathing, rash or changes in skin, and severe diarrhea or vomiting. Fever is one of the first signs of infection. Some of these symptoms can also indicate graft-versus-host disease.
- Report to the ophthalmologist any signs of eye discharge or changes in vision. Patients who undergo radiation or who are on long-term steroid therapy have an increased risk for cataracts.
- Some of the drugs used for leukemia cause extreme sun sensitivity. Sunburn can cause skin infection. Children should wear sunblock and sun-protective clothing when going outside.
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- www.cancer.org -- American Cancer Society
- www.cancer.gov -- National Cancer Institute
- www.marrow.org -- National Marrow Donor Program
- www.asco.org -- American Society of Clinical Oncology
- www.cancer.net -- Cancer.Net
- www.acco.org-- American Childhood Cancer Organization
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Faderl S, O'Brien S, Pui CH, Stock W, Wetzler M, Hoelzer D, Kantarjian HM. Adult acute lymphoblastic leukemia: concepts and strategies. Cancer. 2010 Mar 1;116(5):1165-76.
Hijiya N, Hudson MM, Lensing S, et al. Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia. JAMA. 2007 Mar 21;297(11):1207-15.
Lee HJ, Thompson JE, Wang ES, Wetzler M. Philadelphia chromosome-positive acute lymphoblastic leukemia: current treatment and future perspectives. Cancer. 2011 Apr 15;117(8):1583-94. doi: 10.1002/cncr.25690. Epub 2010 Nov 8.
Morris B, Partap S, Yeom K, Gibbs IC, Fisher PG, King AA. Cerebrovascular disease in childhood cancer survivors: A Children's Oncology Group Report. Neurology. 2009 Dec 1;73(22):1906-13. Epub 2009 Oct 7.
National Comprehensive Cancer Network. NCCN Guidelines Acute Lymphoblastic Leukemia. V2.2012.
Peterson CC, Johnson CE, Ramirez LY, Huestis S, Pai AL, Demaree HA, et al. A meta-analysis of the neuropsychological sequelae of chemotherapy-only treatment for pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer. 2008 Jul;51(1):99-104.
Pidala J, Djulbegovic B, Anasetti C, Kharfan-Dabaja M, Kumar A. Allogeneic hematopoietic cell transplantation for adult acute lymphoblastic leukemia (ALL) in first complete remission. Cochrane Database Syst Rev. 2011 Oct 5;(10):CD008818.
Pui CH, Robison LL, Look AT. Acute lymphoblastic leukaemia. Lancet. 2008 Mar 22;371(9617):1030-43.
Ribera JM, Ortega JJ, Oriol A, et al. Comparison of intensive chemotherapy, allogeneic, or autologous stem-cell transplantation as postremission treatment for children with very high risk acute lymphoblastic leukemia: PETHEMA ALL-93 Trial. J Clin Oncol. 2007 Jan 1;25(1):16-24.
Schrappe M, Hunger SP, Pui CH, Saha V, Gaynon PS, Baruchel A, et al. Outcomes after induction failure in childhood acute lymphoblastic leukemia. N Engl J Med. 2012 Apr 12;366(15):1371-81.
Thomas X, Dombret H. Treatment of Philadelphia chromosome-positive adult acute lymphoblastic leukemia. Leuk Lymphoma. 2008 Jul;49(7):1246-54.
Thomas X, Le QH. Central nervous system involvement in adult acute lymphoblastic leukemia. Hematology. 2008 Oct;13(5):293-302.
Trigg ME, Sather HN, Reaman GH, Tubergen DG, Steinherz PG, Gaynon PS, et al. Ten-year survival of children with acute lymphoblastic leukemia: a report from the Children's Oncology Group. Leuk Lymphoma. 2008 Jun;49(6):1142-54
Yang JJ, Cheng C, Yang W, Pei D, Cao X, Fan Y, et al. Genome-wide interrogation of germline genetic variation associated with treatment response in childhood acute lymphoblastic leukemia. JAMA. 2009 Jan 28;301(4):393-403.
Advanced Studyec
Review Date: 3/8/2013�
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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First Tutors: I.T. helps you to find an IT trainer in Cumbria and across the UK. First Tutors: I.T. profiles Cumbria IT trainers offering help in popular areas such as Microsoft Office packages and Desktop publishing. Professional and business IT training are both catered for across Cumbria as well as IT lessons just for fun. Please use our service to search for IT trainers near you and select which IT teachers best suit your requirements.
Discover through one search the most suitable IT trainer for your needs in Cumbria, whether you are looking for IT training to learn a new programming language, develop a hobby or develop your professional abilities to further your career.
Our search will order IT trainers in your area according to their charges and proximity to you. Subjects include, but are not limited to Microsoft Office training and web design.
If you are an IT trainer wishing to offer your IT training services in Cumbria or anywhere else across the UK, please register with First Tutors: I.T. to commence giving IT lessons or find out more about us here.
Towns: Alston, Ambleside, Appleby-in-Westmorland, Askam-in-furness, Barrow-in-furness, Beckermet, Brampton, Broughton-in-furness, Carlisle, Cleator, Cleator Moor, Cockermouth, Coniston, Dalton-in-furness, Egremont, Frizington, Grange-over-Sands, Holmrook, Kendal, Keswick, Kirkby Stephen, Kirkby-in-furness, Maryport, Millom, Milnthorpe, Moor Row, Penrith, Ravenglass, Seascale, Sedbergh, St. Bees, Ulverston, Whitehaven, Wigton, Windermere, Workington

subset: commoncrawl


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Game Night - Fashion Square
Marbles: the Brain Store
Monthly Event - Third Thursday of every month: 5:30 PM to 7:30 PM (CDT)
Event Details
Get geeked up for game night! Come see us the 3rd Thursday of every month from 5:30 – 7:30 pm.
Just show up by yourself or with family and/or friends, and BrainCoaches will get you started on some fun games that will challenge your cranium!
Come have fun, make new game loving friends, check out some games you haven't played yet, and get your synapses snapping!
Looking for another Marbles location closer to you?
Marbles: the Brain Store
14006 Riverside Dr
Sherman Oaks,
Monthly Event - Third Thursday of every month: 5:30 PM to 7:30 PM (CDT)
Add to my calendar
Marbles: the Brain Store
We're a one-of-a-kind retail store with a smart collection of hand-picked, expert-tested, certifiably fun ways to a healthier brain for all ages.
The best part? Our stores are designed to let you roll up your sleeves and get a little brainy while you play games, solve puzzles, try out software and flip through books to find the right products for you and your noggin.


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Tornados make it two in a row at Benedict QuadrangularSeptember 23, 2009
Rennie takes home medalist honors with 74
Columbia, S.C. - The Tornados men's golf participated in the one-day Benedict Quadrangular yesterday afternoon held at Oak Hills Country Club in
Rennie recorded a 74, 2-over for the tournament in leading the team to the win.
Thomas Bush was close behind, shooting a 77, while a trio of Tornados in Mike Jones, Joshua Davis and Parker Lewis finished with 78s to complete the five-some put on the course by Coach Michael Bayne.
With the win, the Tornados are on a two-tournament win streak heading into next week as Brevard travels to Links Hill Country Club in


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1. Second Acts
Research into elder-friendly design, long-term living, senior living, multigenerational housing, and hospice has flourished over the last quarter century across gerontology, healthcare, planning, and architecture. Defining best practices for the next generation of functional, attractive buildings can only be a collaborative effort. To this end, the Environments for Aging Conference in New Orleans, sponsored in part by the AIA Design for Aging Knowledge Community, helped lay the groundwork for high design and optimal spaces for an aging population, Apr. 6–9.
Learn more at network.aia.org/designforaging.
2. Post-Classic Era
It's often hailed as an underrated masterwork by Philip Johnson, FAIA, but for anyone who's been to the Pre-Columbian Pavilion at Dumbarton Oaks, flying under the radar was entirely the point. Nestled in the trees at the inside crook of the museum's L-shaped site plan, Johnson's supple, marble-paneled piers and glass façade snakes around a hidden square courtyard. Eight circular galleries inside the building contain the Bliss Collection's Moche pots, stone reliefs, and textiles—the best hidden secret in Washington, D.C. The pavilion turns 50 this year, occasioning Dumbarton Oaks's "50 Years of Pre-Columbian Art," which runs through the end of the year.
Learn more at doaks.org.
3. Gulf Coast Green
The Gulf Coast is not just 1,800 miles of coastline; it's hundreds of bays, inlets, marshlands, and lagoons that constitute one of the world's largest hubs of economic activity. Sustainable architecture—which includes flood mitigation, design with ecology, and environmentally friendly materials—matters more now than ever before. Join AIA Houston for the eighth annual Gulf Coast Green Symposium on May 2.
Learn more at aiahouston.org.
4. Scientific Methods
For future doctors, chemists, and scientists, the high school chemistry lab is a foundational experience. For future architects, it's a window into the opportunities in biomedical research environments—and all of the risks involved. Risk and reward will be the central themes of "Guidelines for Laboratory Design: Health and Safety Considerations" (which offers a whopping 38 AIA/HSW credits) at the Harvard School of Public Health, May 6–10.
Learn more at ecpe.sph.harvard.edu.
5. Preservação do Patrimônio
Instiuto de Arquitetos de Brasil (IAB) members have promoted preservation since the early 1980s across the country's 3.2 million square miles. However, industrialization along the coast and in the hinterland imperils conservation and restoration efforts. This year's International Conference on Preservation of Historic Monuments, entitled "ArquiMemória 4," in Salvador da Bahia, takes on the "urban dimension of equity" to find some common ground for heritage conservationists and developers.
Learn more at www.iab-ba.org.br.
6. Drawing Conclusions
When Lebbeus Woods died last year, obituarists struggled to define a man who spent his career rejecting definition. Was he an architect or a draughtsman? Was his art implicitly or explicitly political? Was "experimental architecture" the object of his art, to be built one day, or the subject of his art, to be debated only? Was his worldview dystopian or optimistic—or even naive? "Lebbeus Woods, Architect," featuring 75 drawings at the San Francisco Museum of Modern Art, hopes to answer these questions. Through June 2.
Learn more at sfmoma.org.


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The Top Ten Reasons Working For Someone Else Is NOT Smart
**Reason # 10: You'll spend 90,000 hours of your life working for someone else so you'll get a gold watch and a really cool part-time job at Wal-Mart as a greeter.
**Reason # 8: It's been a rough day. You're home relaxing, watching "America's Most Wanted" on TV and, to your horror, you realize the babysitter you leave your precious children with each and every day is on the FBI Top Ten Most Wanted list!
**Reason #7: You get up when you don't want to, drive someplace you don't want to go, and make a living working with people you really don't like.
**Reason # 6: Would you be wearing something different if they didn't tell you how to dress?
**Reason # 5: Your company may think it's really cool to let you go. "Newsweek" Magazine says firing people has gotten to be trendy in corporate America.
**Reason # 4: Asking for time off is too much like asking your parents for permission.
**Reason # 3: Good News. You've survived the downsizing. The bad news is that you have to go home and tell the family you're being transferred to a country you did not know existed.
**Reason # 2: Elephants work for peanuts – why should you? Shouldn't you be paid what you're really worth?
**Reason # 1: Yes, the Number 1 reason why working for someone else is just plain dumb: this is America and you don't have to!
Yes, America is still the land of great opportunity but it's just not in the same place you're used to looking. You know, people who work half as hard as you do, and are earning great part-time incomes, taking dream vacations and even making fistfuls of money. What's your excuse for not building your own successful business? What have you got to lose except a BOSS? Perhaps we can add another reason to this list. Why work for someone else, when you can work for yourself doing something you LOVE – sharing the joy and excitement of shopping and travel for fun and profit? If you still haven't made the decision to become a home-based business owner, why not make today the day. CLICK HERE, and discover why we're so Flat Out Excited!
Check in with you later!
This posting was orignally made on my My Space profile and blog on June 02, 2007. I felt it necessary to share it with you here…have an awesome day!


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7 Series - E38 (1995 - 2001)
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2001 BMW 740IL Timing Chain Rep. Cost?
I'm looking at buying a BMW 740IL in my area. It has 148,000 miles on it. The guy is asking a good price for it because it needs engine work. He told me it's making a ticking noise from the engine bay. He took it to a mechanic and he said that it could be the timing chain. I originally wasn't going to buy anything but the 7 series are my favorites, especiallyy the E38's. If I can get this one at a decent price and get it fixed, I'll be very happy.
Are are the average costs to replace a Timing Chain. What other possiblities are there as well?
He told me it's like a ticking noise. He also described it almost like a knocking noise, but he hasn't driven it in 3 months.
I am mechanically inclined, but when it comes to jobs like these I'm not in for it.
Any suggestions?
Knocking is never a good thing, I have a timing problem and I am in over $1000 in just parts and tools and the problem is still kicking my butt. If it is a rattle you may have broken guide rails, knocking sounds like valves. I'm not an expert but unless you are willing to replace the engine or rebuild it is not worth it. I got a super great deal on my 2000 740i but it has been sitting for 3months and it's not because I have not worked on it, from what I have seen and heard the timing wil run you a couple thousand to fix. I am a DIYer so I am comfortable doing the work, but the special tool needed to do the timing will run you about $350- $420 + the parts. I would suggest getting one that is in better runnig shape, I promise you will be happier, you may have to spend a thousand or so more but it will be worth it. It is an awesome ride you will fall in love with it.
Last edited by awright1412; 12-01-2012 at 02:30 PM.
my brother has a 2007 5series and his makes the ticking sound,it's an itty bitty ticking sound,i heard that ticking sound is normal...but knocking is not normal...if it only ticks than i would not worry about it (itty bitty tick).i have a 01 740il sport and mine ticks but purrs like a kitten other than that ticking.fun car man
I'd stay from that car if I were you. Having to replace your Timing Chain Guide is spendy. Depending on where you go, it can cost up to $3000.
Easiest way to find out if its timing guides, is drop the oil pan and look for bits of plastic in the pan. If you have it, it becomes a pricey job. Minimum an indy shop will charge is 3K. If an indy shop quotes less than that, i would seriously question their abilities.
This is a big job. Can be a DIY depending on your mechanical abilities, but its still a big job none the less. Shops quote between 22 and 25 hours for it. And trust me, after doing this recently, it takes about every minute of it. For a DIYer your probably looking closer to 30 to 35 hours following step by step instructions.
Unless you have cash to burn and your getting this car for next to nothing.. Steer clear.
If you take a gamble and buy it, and plan to do the work yourself. Plan on spending between 1100 - 1500 just in parts and special tools. Thats about what it ran me, because once you start ordering parts, you start replacing parts that could be suspect along the way. Ie water pump, gaskets, hoses, etc etc etc... It adds up quick...And the parts you replace are parts that you dont want to skimp on and not buy OEM... BUY OEM for these parts if you do it...
Just my two cents... which is worth 37 dollars and change,,,stay thirsty my friends...LOL
1997 Black 740IL (w\ badass Phone in console)
Last edited by ou18; 11-30-2013 at 09:05 AM.
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- Beginner Loop Horse Trail closure
- Blue-Green Algae: Found in lakes year round. More information.
- Suicide Hill Closure
- Mountain Grove Trail Closure
Deam Lake is forest property designed for recreational activities. Under the multiple use concept, a variety of compatible activities are available. These include fishing, boating, swimming, camping, picnicking, hiking and hunting in designated areas. The 194-acre lake was constructed in 1965 and was named in honor of Charles Deam, Indiana's first state forester. Deam is best known for his book, Trees of Indiana, a comprehensive study of trees throughout the state. He was also instrumental in getting land set aside for what is now the Department of Natural Resources.
Deam's books Trees of Indiana and Shrubs of Indiana are available from the Historic Hoosier Hills RC & D. Books are $16 plus $3 shipping. To order, contact:
Historic Hoosier Hills Woodland Committee
P.O. Box 407
Versailles, IN 47042
SPECIAL NOTICE--Several volunteers are needed for a variety of events at Deam Lake SRA. For details or to sign up as a volunteer, please contact the Deam Lake office at (812) 246-5421 or email at firstname.lastname@example.com.
Deam Lake has 116 class "A" campsites and an additional 68 class "A" sites in the horsemen's campground. The horsemen's campground has two short lead-outs to connect to the 80 miles of horse trails in Clark State Forest. Class "A" facilities include electrical hookup, modern restrooms/showers (at least one shower station wheelchair accessible), picnic table, fire ring and parking spur. Drinking water and a dump station are also available in the area.
Class A campsites will be available for reservation up to six months in advance by simply calling a toll-free telephone number or logging onto the Internet. Campers will be able to make reservations by calling, toll free, 1-866-6CAMPIN (1-866-622-6746) Monday through Thursday from Noon to 8 p.m. Eastern Standard Time, Friday from 8 a.m. to 6 p.m., and Saturday between 8 a.m. and noon E.S.T. They may also log onto the Internet 24 hours a day at http://www.camp.in.gov/
Rent-a-Camp Cabins
Deam Lake State Forest Recreation Area has 12 rent-a-camp cabins, available seasonally (call property office for dates), including three in the horsemen's campground. Each cabin has a front porch with a swing, outside electric outlet and front porch light. Inside, there are two small rooms each providing a ceiling fan with light, a heating/cooling unit and electrical outlets. The front room offers a small table with bench seats, corner shelf, chair, rocking chair, and a loft. The back room offers a bunk bed (single) and a double bed (NO LINENS or MATTRESS PROVIDED). Air mattress recommended. Reserve cabins online at Camp.IN.gov. (NOTE: On-site sales only during off season/winter months, contact property for details). No pets, smoking or cooking permitted in cabins.
194-acre lake; a valid Indiana fishing license is required. Boat launch ramp; boat motors are limited to electric trolling motors only. Rowboat rental is available from Memorial Day weekend through Labor Day weekend. The swimming beach is available from the Saturday of Memorial Day weekend through Labor Day. Restrooms, dressing facilities, showers and food concessions are available to visitors. A wheelchair ramp allows access to beach area. Rowboat rental is available.
Whitetail deer, ruffed grouse, turkey, squirrel, fox and raccoon. A valid hunting license is required.
There are picnic areas and a picnic shelterhouse available for day use. Picnic tables and grills are located at the picnic sites. There is a playground area near the beach.
Forest Education Center
The Forest Education Center at Deam Lake is managed by a full-time naturalist who provides a variety of forestry-related programs throughout the year, as well as several special events, field days, and other field trip opportunities. Prior registration is required for groups of 10 or more, and all programs and field trips are free of charge with admission to Deam Lake. The Forest Education Center is wheelchair accessible, and is open beginning Memorial Day weekend from 8:30 am-3pm Wednesdays and Thursdays, and from 11 am to 5 pm on Friday through Sunday. Times, dates and topics of interpretive programs and events vary from week to week. Please visit the Forest Education Center, Office, Gatehouse or campground kiosk for detailed information. For more information, please call (812) 246-5421 during regular operating hours.
Volunteer Opportunities
There are several volunteer opportunities at Deam Lake, spanning a broad range of knowledge, experience and skill sets.
Opportunities include:
To apply or inquire about any of the volunteer opportunities listed above, please call (812) 246-5421.
Hiking Trails
Deam Lake SRA is home to five hiking trails, which range from easy to rugged. All trails are marked with white paint blazes. At certain points on Trails 3 and 4, you may encounter trees with two white paint blazes. Two blazes means that there is a split in the trail (horse trails and rogue trails often confuse hikers), and that you should locate the next white paint blaze before continuing. Descriptions of each trail can be found below. Hikers are advised to wear hunter orange or other bright clothing while on trails during hunting season. Should you have any further questions regarding difficulty, trail updates, or problems, please call (812) 246-5421 during regular operating hours. In addition to Deam Lake's hiking trails, a trailhead to the Knobstone Trail is also located on the property.
A Note to all hikers
You are welcome to report to the office or Forest Education Center before and after your hike if you feel it may be safer. None of the trails are extremely difficult, but changing weather scenarios can make traversing some areas a challenge. Be sure to pack plenty of water before any extended hike. Additional supplies such as a compass are suggested, but not necessary as all trails have been marked. If any horse riders are encountered on any trail except for Trail 3, please report their presence to the office, Forest Education Center, or our Naturalist. We also ask that you carry out all supplies and trash that you carry into the trails, as we are not staffed adequately to do regular trail cleanup.
Mountain Bike Trails
Deam Lake S.R.A./Clark S.F. offers 5 miles of mountain bike trails. Mountain bikes are only permitted on those designated trails. View our publications page for further details and a trail map.


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Strongsville bargaining produces no deal
(Independence) - Negotiations resumed Sunday in hopes of ending the Strongsville school strike. The union and the board returned to talks at the federal mediator's office in Independence at 3pm.
The eight hour session produced no new deal although the union offered to extend the school day by thirty minutes at no cost to the district, a proposal shot down by the school board.
Parents were there, holding signs urging both sides to reach an agreement today. They claim students are falling begin with the school year nearly over.
Superintendent John Krupinski, says he optimistic but maintains any agreement would be to be affordable and sustainable.
Striking Strongsville teachers stopped picketing Friday as a symbolic gesture. However, Tracy Linscott, president of the Strongsville Education Association says if talks are again unsuccessful, teachers will be back on the picket line Monday.
Linscott accuses the school board of prolonging the strike to win at any cost. She contends both sides are actually very close on most of the issues and maintains the board has saved more than enough money with strikebreakers to afford a settlement with the teachers.
John Krupinski
The last session with the federal mediator took place April 14th, but ended without an agreement after 12 hours of negotiations.
(Photos by WTAM's Ken Robinson)
Get breaking news sent to your mobile phone. Text "news" to 21095.
(Copyright 2013 Clear Channel, all rights reserved.)


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We have a lineup, and I would expect this to be the opening day lineup
Choo 8, Phillips 4, Votto 3, Ludwick 7, Bruce 9, Frazier 5, Cozart 6, Hanigan 2, (Olivo DH, Cingrani LHP)
We have a lineup, and I would expect this to be the opening day lineup
Choo 8, Phillips 4, Votto 3, Ludwick 7, Bruce 9, Frazier 5, Cozart 6, Hanigan 2, (Olivo DH, Cingrani LHP)
Last edited by Matt700wlw; 02-22-2013 at 11:16 AM.
I was just going to post this, but was checking to see if we did ST games in this part of the forum last season or not.
I know whomoever was going to start was only going to go 2 innings at most, and I know they are likely setting things up with the longer ST to hold back the expected starters a bit, but with the first game of ST, when a good portion of cincy will be tuning in and getting the baseball juices flowing, I'm surprised they went with Cingrani rather than Bronson or Leake or Homer or Latos, etc..
At any rate, it will be good to hear Marty and the gang again.
From 700WLW: (Note that you cannot get the game via 700WLW.com)
The Reds take on the Indians in Cactus League Action. Marty and Jeff have the first pitch of Spring Training baseball at 3:05.
Read more: http://www.700wlw.com/pages/programm...#ixzz2LeIVvugV
EDIT: Here are also the XM Satellite radio channels the Reds are on.
Last edited by goreds2; 02-22-2013 at 01:38 PM. Reason: Added XM link
* Attended the 1990 and 2010 Reds Division clinchers *
Watched the 2012 Clincher on FOX.
Girlfriend is a UK fan
GO STEELERS - Go Buckeyes - Go SIXERS
Oh man, you guys. It's back!
"I never argue with people who say baseball is boring, because baseball is boring. And then, suddenly, it isn't. And that's what makes it great." - Joe Posnanski
Superdude (02-22-2013)
OnBaseMachine (02-22-2013)
Uncle Drew holding down the 9-hole for the Tribe.
It's great to be back. Hopefully this is the start to the Road to the World Series. Here's the Indians lineup. Stubbs in RF.
1. Michael Bourn (L) CF
2. Asdrubal Cabrera (S) SS
3. Jason Kipnis (L) 2B
4. Nick Swisher (S) 1B
5. Michael Brantley (L) LF
6. Carlos Santana (S) C
7. Mark Reynolds (R) DH
8. Lonnie Chisenhall (L) 3B
9. Drew Stubbs (R) RF
Reds Fan Since 1971
"Since I've been with the Reds in 1989, we've never had a farm system this loaded," Bowden said. "If we were the New York Yankees and had unlimited dollars, we could have traded for Colon, (Jeff) Weaver, Rolen, (Cliff) Floyd, (Kenny) Rogers and Finley and gotten them all -- and still held onto our top five prospects. That's an amazing statement."
"You can learn little from victory. You can learn everything from defeat."
-- Christy Matthewson
"Show me a good loser and I'll show you an idiot."
-- Leo Durocher
38 games to go before the show starts. Anyway, it's time to play baseball, who can complain?
Will Choo and Drew go to the wrong dugout at some point?
Can't win with 'em
Can't win without 'em
I'm so excited! So awesome seeing Choo at the top of the Reds lineup.
I christen the U.S.S. GameThread with a 12 ounce bottle of Burger Beer!
"Baseball is a very, very complex business. It's more of a people business than most businesses." - Bob Castellini
*BaseClogger* (02-22-2013)
Board Moderators may, at their discretion and judgment, delete and/or edit any messages that violate any of the following guidelines: 1. Explicit references to alleged illegal or unlawful acts. 2. Graphic sexual descriptions. 3. Racial or ethnic slurs. 4. Use of edgy language (including masked profanity). 5. Direct personal attacks, flames, fights, trolling, baiting, name-calling, general nuisance, excessive player criticism or anything along those lines. 6. Posting spam. 7. Each person may have only one user account. It is fine to be critical here - that's what this board is for. But let's not beat a subject or a player to death, please.


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Bob Seger Unveils New Album Details
Listen to Bob Seger Radio on iHeartRadio
Bob Seger's new album is coming this fall. The rocker will release Ride Out, his follow up to 2006's Face The Promise, on October 14th.
Bob says he's happy with the disc. He explains that the material "sums up a lot of feelings" he has about personal and current social issues. Seger is also confident he's tapped the viewpoint of his audience. He says the songs reflect how "we appreciate things as simple and pure as love, to navigating through the corruption and violence that permeates the news."
Bob has unveiled one track from the album, a cover of John Hiatt's "Detroit Made." Fans who saw Seger in concert last year might be familiar with two other songs as well. Bob played the tracks "All of the Roads" and "California Stars" on his 2013 tour.
Photo: Getty Images


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Slow Food is an international organization revolutionizing the food system to create a world where food is good for the people who eat it, farmers who grow it and the planet which produces it.
Become a Member Today
Discover all the great benefits you receive by becoming a member as well as the wonderful programs your contributions support.
View Upcoming Events
We're bringing you more ways to get involved with Slow Food Atlanta than ever before. Check them out!
Volunteer Opportunities
As an entirely volunteer-run organization, our growth depends on dedicated and enthusiastic members. Find out how you can help today!


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What's new in the 2014 Swift?
In Fact, nothing new. Apart from the i-20-imitating Daytime Running Lights and the new golden colour, the pictures released by Suzuki's Belgian website don't reveal anything new. Details are not available on whether there are any changes to the mechanics or the interiors of the vehicle. The Japanese carmaker will also introduce 4-wheel drive on the Swift crossover, which is expected to debut later this year at the 2013 Frankfurt Motor Show.
Take a look at this extensive image gallery and if you manage to spot anything new in the 2014 Swift, share it in the comments section below.


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Cheryl - from Lincoln, NE
You are right! In trying to keep down the cost of what you pay for a cake mix, manufacturers have been slowly reducing the amount of mix in a box! Depending on the manufacturer, cake mixes now make between 4-3/4 and 5-1/4 cups batter. Unfortunately, there is no way to increase the amount of batter you get from a mix – if your favorite cake mix is on the lower end, try one of the other brands of cake mix. Your only other option is to make more than one mix.


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Your shopping cart is empty!
Arsenal 2004 home long sleeve double layer player's version game shirt.Features embroidered team crest and logo,Felt placed sponsor in front.Mesh panels on each side for breathability,Elastic cuffs and neck.100% polyester.EU Product.
Soccerplus first opened in 1994. We were one of the first soccer websites to hit the webView more
Address: 1640 E. Washington Blvd.
Pasadena, Ca 91104, USA
Phone: 1-800-945-7291
Get Direct


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Want to know if celebrities really love you or are just pretending? Invite them to get some free stuff and see who shows up.
Selena Gomez
Jennifer Lopez
Kerry Washington
Amy Adams
Jennifer Garner
Lea Michele
Busy Phillips
Tyra Banks and Chrissy Teigen
Jessica Chastain
Anna Faris
Leslie Mann
Kristen Bell


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|This page is an archive. Please do not edit this archive, instead try editing the page this archive originated from.
Hand Seals?
where did you get those hand seals. From what ive seen, it appears that the shadow clone uses a single handseal unlike those on the page.
Shuriken Kage Bunshin no Jutsu
It seems that Ninjas can make shadow clones of objects, not just themselves. When fighting Orochimaru the 3rd Hokage threw a single shuriken and then made multiple copies of it to turn it into a swarm (Chapter 117).
In episode 190 of Naruto Shippuden, Naruto and the Old Soldier, this jutsu makes another appearance. Should we mention this? —This unsigned comment was made by 126.96.36.199 (talk • contribs) .
Jutsu Level
I thought the Shadow Clone Jutsu was a Jonin Level Technique. Izumo Kamizuki said that in Naruto Episode 60 when Naruto went up against Neji in the Chunin Finals. - Zero - Talk 11:49, 14 December 2008 (UTC)
Gaara fight
It says that he made 1999 clones using the fox's chakra, but Naruto doesn't use the fox's chakra until he needs to summon gamabunta, meaning that he can create 1999 clones with his own chakra reserves
No he actually made 999 clones every clone hit gaara tow puches.--Charmanking2198 (talk) 02:44, August 14, 2012 (UTC)
Based of what is stated in chapter 433, pg 9. It is safe to say that at the dispelling of shadow Clones that any chakra remaining since their creation goes back the user when dispelled. SuperN 15:02, 30 January 2009 (UTC)
When Guy disappears after talking to Lee and Team 7 in episode 22, he disappears like shadow clones do. Is there anything to that, or am I just imagining things? Hakinu talk | Contributions 11:27, 22 May 2009 (UTC)
- Well, they dont show much about guys abilities, other that taijutsu...Apparently he can summon, but he did it only once....he can probably use ninjutsu, as lee was the first person to graduate frm the academy, with taijutsu alon, but i think he's stickin to taijutsu, to make lee feel better, and to prove u dont need ninjutsu....so, ya he prob can use it...ost jounin's can....but i dont think we'll evr find out, unless he fights an opponent that fources him to use ninjutsu..AlienGamer | Talk 11:31, 22 May 2009 (UTC)
- I would guess that it was the Body Flicker Technique. Jacce | Talk 12:06, 22 May 2009 (UTC)
- That would make sense. /Agree Hakinu talk | Contributions 12:45, 22 May 2009 (UTC)
- I would guess that it was the Body Flicker Technique. Jacce | Talk 12:06, 22 May 2009 (UTC)
Chapter 412, page 9.
Fukusaku says that it would be the end of naruto if any of his clones turn into frogs. Also, shouldn't this be listed as a training method as well?184.108.40.206 (talk) 22:26, 23 May 2009 (UTC)
about kakashis dissapearing in part 1and 2
in part2 when he reveals him self to the new sakura and naruto he says my bad my bad auctually an old lady wanted some help and i and they said its a lie he may have used a shadow clone jutsu Sartorias (talk) 18:25, 10 August 2009 (UTC)
Distributing Chakra
Just to clarify something mentioned in the article, where it says that chakra is evenly distributed amongst the clones, is it referring to each clone having the same amount? Or does it work on the basis that if, say, Naruto makes one clone, his chakra is instantly halved? Or if he makes 1999, he's only left with 1/2000 of what he had? Dartblaze (talk) 09:10, October 16, 2009 (UTC)
Just saying
Naruto can put how much chakra he wants into each clone the chakra is not evenly distributed among the clones. The strength is the same without any cost but the chakra is decided by naruto.—This unsigned comment was made by Uchiha, Ichigo (talk • contribs) .
Neji made it clear that the chakra was equally distributed between the clones in chapter 100 page 6.Jacce | Talk 09:35, October 16, 2009 (UTC)
Shuriken Kage Bunshin No Jutsu
The shuriken clone techniquie is not as simple ans others ans you have to focus your chakra into an inanimate object to make exact solid copys of it.
It also uses up more chakra than you would think—This unsigned comment was made by Uchiha, Ichigo (talk • contribs) .
Yah, nagato Animal Path (or his summon uses it?) uses this in his fight with jiriyia, anime only. Also, remove Bunshinjutsu and see also and set Jutsu classification=Ninjutsu, Bunshinjutsu Simant (talk) 23:36, October 17, 2009 (UTC)
Mistake in Multiple Shadow Clone Technique description
It is said in the article that Naruto needs the Kyuubi's chakra to make multiple shadow clones. That is clearly wrong. He makes multiple shadow clones using his own chakra, as seen in the very first chapter/episode, when he apparently did not know to use the Kyuubi's chakra. Geijustu wa bakuhatsu da (talk) 16:52, November 15, 2009 (UTC)
- Ebisu said that since the fox chakra is always mixing with Naruto's own, he has trouble molding chakra. So he is always using some fox chakra. Jacce | Talk 17:10, November 15, 2009 (UTC)
I think Enma used this technique - it's a parent jutsu of Adamantine Prison Wall.--18.104.22.168 (talk) 21:31, March 12, 2010 (UTC)
- The one databook translation I found doesn't make any indication that they're shadow clones. ~SnapperTo 23:14, March 12, 2010 (UTC)
When did Deidara used this? Jacce | Talk | Contributions 06:40, May 15, 2010 (UTC)
- During his fight against Team Kakashi and Team Guy. He did it offscreen. 07:52, May 15, 2010 (UTC)
- Shadow clones are a component of Suicide Bombing Clone. ~SnapperTo 16:54, May 15, 2010 (UTC)
Title in question?
I thought this move was called Kage Bushin no Jutsu. Why is it Shadow Clone Technique? I think the articles on this wikia should be refered after what they are called in Japan and not by what a dubbing/subbing company calls it because it can lead to confusion. We can say "in the english versions, it is called the Shadow Clone Technique" but the article itself is different. (220.127.116.11 (talk) 21:13, November 3, 2010 (UTC))
- We use the literal translation of the Japanese names, save for some exceptions, such as techniques which are names of deities, Chidori and Rasegan, as well as their variants. Omnibender - Talk - Contributions 22:08, November 3, 2010 (UTC)
- Uhhh...I am aware of kage meaning shadow and bushin meaning means clone, but if that's the wikia's rules, I will respect that. I only think we should use the original name, but like I said, I respect the rules (22.214.171.124 (talk) 22:16, November 4, 2010 (UTC))
Shadow clones X2
Can a shadow clone use shadow clone jutsu? --Elvesyou 19:27, November 25, 2010 (UTC)
- Technically speaking, yes. —ShounenSuki (talk | contribs | translations) 22:06, November 25, 2010 (UTC)
- So by that logic say naruto summons 10 shadow clones (splits his chakra into 10 equals) then that shadow clone makes 10 more and so on doesn't that mean that the clones will have less and less chakra? --Elvesyou 20:11, November 26, 2010 (UTC)
- Technically speaking, yes. —ShounenSuki (talk | contribs | translations) 20:15, November 26, 2010 (UTC)
- So by that logic say naruto summons 10 shadow clones (splits his chakra into 10 equals) then that shadow clone makes 10 more and so on doesn't that mean that the clones will have less and less chakra? --Elvesyou 20:11, November 26, 2010 (UTC)
- so by that sense an unlimited amount of shadow clones can be made and the user doesn't have to waste chakra, so in other words, the user really only has to make one batch while the "pre" existing shadow clones make the rest, correct?. --Elvesyou 15:53, December 11, 2010 (UTC)
- Technically speaking, yes. —ShounenSuki (talk | contribs | translations) 20:45, December 11, 2010 (UTC)
- so by that sense an unlimited amount of shadow clones can be made and the user doesn't have to waste chakra, so in other words, the user really only has to make one batch while the "pre" existing shadow clones make the rest, correct?. --Elvesyou 15:53, December 11, 2010 (UTC)
- So by that logic anybody can make an unlimited amount with no risks? --Elvesyou 23:13, December 11, 2010 (UTC)
- With no benefits as well, since the clones would have less and less chakra, making them pretty much useless. Omnibender - Talk - Contributions 23:22, December 11, 2010 (UTC)
- Yes but any normal shadow clone dissipates after one hit, so really it would make no difference, and really there is no down-side as, they would eventually get to the stage of being to hard to fight because of the sheer numbers (excluding to Sharingan, Rennigan, Byakugan and that unnamed dojutsu users), plus it's costing the user no chakra whatsoever, meaning it's pretty much an unlimited amount of shadow clones, so really I don't see a downside, well apart from the fact that their considerably weaker because of the lack of chakra, though they all have access to nine-tails power, so that could compensate. --Elvesyou 23:31, December 11, 2010 (UTC)
- No, Omnibender is right. Making shadow clones like this will eventually become useless. Several of the advantages of the technique disappear when you take on this tactic:
- Shadow clones are usually indistinguishable from the user, but with this tactic that is no longer the case.
- Shadow clones can usually do techniques, but with this tactic they no longer have the required chakra.
- Shadow clones are usually rather durable and good enough to at least hit the enemy once, but with this tactic they would be barely more durable or useful than normal clones.
- The shadow clones might actually be in danger of disappearing because of having too little chakra.
- —ShounenSuki (talk | contribs | translations) 23:50, December 11, 2010 (UTC)
- Okay I see your point in that however using other jutsu's to take the user underground or hide them would compensate for distinguishing the user but they would have to get through the clones, which in fact can be used as a sort of trap I guess as you could exploit disadvantages to your advantage, and maybe not to use the tactic to much, cos after the clones are gone the chakra returns to the user.
- the way I mean isn't to use it all the time, I just mean rather than constantly having to use it, but instead in a chakra saving way, I will give an example. The user is fighting in rocky terrain and has a fair amount of chakra (enough to make 20 clones and perform 2 rasengans) they need 1 clone for rasengan leaving 19, 8 shadow clones use shadow clone jutsu and each make 20 and have them transform into rocks, now the other 9 or so distract the opponent while rasengan's charging then when ready the clones spring up and fight and are taken out, the clones make more while naruto is running at the opponent, gaining his focus the clones keep him still while naruto delivers the final blow
I don't see a real problem there? --Elvesyou 00:08, December 12, 2010 (UTC)
- The chakra doesn't return to the user. At least not all of it. if it did, the Multiple Shadow Clone Technique would never have been considered so dangerous.
- Any way, your tactic is unnecessary for Naruto. He doesn't need to be careful with chakra in that way, nor would he be able to think up tactics as complicated as this one. Nor does it fit his style, as he would simply use the Multiple Shadow Clone Technique and do the same things without problem. In fact, he did so during his fight with the Deva Path Pain.
- Yes, what you're suggesting is technically possible. However, for anyone who might want to use it, it is infeasible and for anyone who could use it, it is unnecessary. —ShounenSuki (talk | contribs | translations) 01:28, December 12, 2010 (UTC)
- Yeah I guess Naruto isn't exactly the best person to use, then again this tactic could also be applied for searching. Because it is definitely more effective than its pre-decesser, all in all it all depends on the user to need strategies like this, people like Shikamaru for instance. --Elvesyou 01:35, December 12, 2010 (UTC)
I take it the recent manga chapters confirm the statement that Shadow Clones makes Shadow Shadow Clones 18.104.22.168 (talk) 18:37, November 1, 2011 (UTC)
Im not entirely sure about the manga, I didn't really read it until part 2, but I remember in one of the first episodes of the anime Naruto drinks bad milk and he and his clones fight amoungst each other over a toilet. I think there have been other instances of this too. I know it has only been for comedic purposes, but isn't it worth noting maybe just in the trivia section that shadow clones (at least Naruto's) have displayed some degree of freewill/can disagree with the user's will? Not entirely sure on the phrasing so i'll leave that to someone else. —This unsigned comment was made by 10TailedDemonChild (talk • contribs) .
So the downside to a clone is less chakra then the jutsu user, then does that mean the shadow clone gets all or a portion of intelligence? Just wondering SusanooUnleashed (talk) 06:37, April 27, 2011 (UTC)
In actuality, they are just as intelligent as the original. The clones are the ones that remind Naruto they are the same person. Also to further prove they have free will, they all fall asleep on Naruto while he is sitting on a bed bored out of his mind (I think) and yells "IT'S NOT NAP TIME!". You've gotta take it up a notch. 00:49, July 7, 2013 (UTC)
Shadow Clone vs. Sharingan
Yes, sasuke says that he can tell but the article says through events in the series that he is actually just tacking the original that he actually tell. But through what events i need a reference of sorts to validate the statement —This unsigned comment was made by KitKatgakure (talk • contribs) .
- Early in their fight in the Valley of the End, don't remember which chapter or episode. Omnibender - Talk - Contributions 20:52, April 26, 2011 (UTC)
- Episode 130, couldn't find the same in the manga. Jacce | Talk | Contributions 05:09, April 27, 2011 (UTC)
- I'm about 95% certain that this was one of those anime mistakes, meaning it never was in the manga. —ShounenSuki (talk | contribs | translations) 10:20, April 27, 2011 (UTC)
- Episode 130, couldn't find the same in the manga. Jacce | Talk | Contributions 05:09, April 27, 2011 (UTC)
Usage by Konohamaru / Different hand seal?
During episode 161 ("Surname is Sarutobi, Given Name Konohamaru"), Konohamaru performs the Dragon hand seal, even though it had no immediate effect - while still producing that distinct sound that "plays" when the seals for a jutsu are completed -, and later it turned out he was a Shadow Clone. While it is possible that he set everything up beforehand, isn't it also a possibility that at that point, the Dragon seal was used to create the clone? I mean, it is known that for different individuals, the hand seals needed for the same jutsu can differ, and the same person, if practiced the jutsu, might need different hand seals than he did earlier, so this could make sense, couldn't it? SpecB (talk) 12:19, July 23, 2011 (UTC)
- I wouldn't say so. People have always been very clear with Shadow Clone hand seal, and the only thing we know that can change about handseals is making the sequence shorter if you're a master of the technique. I don't see that happening with the shadow clone, since it's only one seal. Omnibender - Talk - Contributions 21:44, July 23, 2011 (UTC)
- I was thinking the same first, but I couldn't make sense of a few things. First of all, like I mentioned, the typical... how should I call it, "jutsu activation sound effect" can be heard, and we know that unless it's a more complex technique - one we wouldn't expect from Konohamaru -, jutsus can take effect from that point. Also it should be noted that Konohamaru was never shown to know more jutsu. Then again he could have set the clone up earlier, since he knew what was going on with Ebisu, and maybe the sound effect was put there as a mistake - I'm not sure if the "ba-" onomatopoeia is the sound of his hands clapping, or is it the jutsu's -, but it'd be pretty pointless to have that much emphasis on a hand seal that serves no purpose. SpecB (talk) 12:49, July 25, 2011 (UTC)
- You're right, that emphasis on the hand seal did serve a purpose: it showed us Konohamaru was capable of doing more than just basic techniques and the techniques taught to him by Naruto, without Kishimoto-sensei actually having to show us the techniques.
- Making Konohamaru use an alternative hand seal for a technique as iconic as Kage Bunshin without clearly showing us that would be pathetic writing on Kishimoto-sensei's part. I'd be more willing to assume he isn't such a poor author. —ShounenSuki (talk | contribs | translations) 17:26, July 26, 2011 (UTC)
- I was thinking the same first, but I couldn't make sense of a few things. First of all, like I mentioned, the typical... how should I call it, "jutsu activation sound effect" can be heard, and we know that unless it's a more complex technique - one we wouldn't expect from Konohamaru -, jutsus can take effect from that point. Also it should be noted that Konohamaru was never shown to know more jutsu. Then again he could have set the clone up earlier, since he knew what was going on with Ebisu, and maybe the sound effect was put there as a mistake - I'm not sure if the "ba-" onomatopoeia is the sound of his hands clapping, or is it the jutsu's -, but it'd be pretty pointless to have that much emphasis on a hand seal that serves no purpose. SpecB (talk) 12:49, July 25, 2011 (UTC)
Usage with Body Replacement Technique
Another thing I have been thinking of, is that a lot of times Naruto performs the Shadow Clone Technique, with a few clones showing up, surrounded by smoke(-ish something), so we get to know which one is the real, but then it turns out that one was a fake. I'm assuming that when performing this jutsu, a kind of Body Replacement Technique is also carried out so the original body remains hidden among the clones. This would also make sense considering the nature of this technique: creating real bodies and evenly distributing the chakra among them serves the purpose that they can't be distinguished, but if the original stayed at the same place as they did before the jutsu, then it probably wouldn't be a big deal to follow the movement of the original with, say, the Sharingan, or even if the opponent has keen reflexes and can stay focused while battling the clones. This would also go along with the "fact" that apparently higher-level shinobi don't need to perform hand seals for the Body Replacement Technique - although it would raise a question as well, namely that we never saw Naruto use it, so in the end the most logical option is that the Shadow Clone Technique includes the Body Replacement Technique as a sort of "bonus". Any thoughts? SpecB (talk) 12:35, July 23, 2011 (UTC)
- Logical reasoning, but since something like this was never even hinted in the manga, I don't think it should be mentioned. Sometimes the smoke doesn't dissipate fast, so there might be a time for the real one to move around without actually using BFT. Omnibender - Talk - Contributions 21:44, July 23, 2011 (UTC)
Experience Question
Has it been stated whether or not the knowledge that the clone gains only goes to the original or would it go to the original and their other active clones? Skitts (talk) 19:14, October 23, 2011 (UTC)
- It's only been said that it does back to the original, nothing of the clones.--Cerez365™ 19:16, October 23, 2011 (UTC)
- It goes to all clones, we've seen it. When Naruto got tips about wind nature transformation from Asuma, he dispersed one clone, and all others, original and clones, learned the trick. Omnibender - Talk - Contributions 19:58, October 23, 2011 (UTC)
Ah, thanks for the answer. Was that anime-only? I was wondering because I remembered that after Itachi took down Nagato, Naruto made a clone that screwed with his Rikudo Mode and it dispersed, so I was wondering whether that meant all of the clones knew of what went on with Itachi and Nagato. Skitts (talk) 22:43, October 23, 2011 (UTC)
- I think that happened in the manga as well, though I'd have to check to be sure. Either Naruto clones know it and we were simply not shown this, or maybe since the clone was too feeble, it didn't get to become aware of things so when it dispersed, there was nothing to send back? Or maybe they're so far apart that it takes a while for the information to reach the clone? Naruto and Fukasaku summoned his clones from Myobokuzan, so my guess is that either it would take too long for the information to reach them, or that the chakra which returns to the original, with the experience and all, would simply disperse along the way before it reached the others or the original. Omnibender - Talk - Contributions 23:03, October 23, 2011 (UTC)
bunshin produce bunshin
so, after manga goes this far.I have question i was think. Can a clone makes another clone? (and why ?) because in part 1 and shippuden , naruto never do that until the chapter when naruto's clone fight real madara. --Jumpjet (talk) 12:06, October 28, 2011 (UTC)
- Shadow clones can use any technique that the original can once they have sufficient chakra. In chapter 561 you saw his clone make more clones.--Cerez365™ 12:25, October 28, 2011 (UTC)
- The clones have never needed to before, because they have never been split up like this--Deva 27 12:37, October 28, 2011 (UTC)
Can the original user multiple objects with Shadow Clones?
For example: Naruto holds an apple. He does the Shadow Clone Jutsu. Does the clone has an apple now too? --22.214.171.124 (talk) 19:38, February 1, 2012 (UTC)Saki
- I think so. Whenever Naruto has cloned himself, the clones has the same equipment, like kunai and shurikens, as the original. Jacce | Talk | Contributions 20:04, February 1, 2012 (UTC)
- Yes. As evidenced by each wearing clothes, right xD (funny how easily we tend to forget things like that)? Also, look at All Directions Shuriken; each clone throws shuriken from their weapons pouches (another duplicated item xD!). --ScruffyC (talk) 21:56, October 23, 2012 (UTC)
- No thought provoking, this isn't a forum. Omnibender - Talk - Contributions 23:45, October 23, 2012 (UTC)
About the trivia
Did not Madara state he can tell the difference between the real one and a wood clone ? --Elveonora (talk) 22:59, March 9, 2012 (UTC)
He could see through Hashiramas Wood Clone Technique. SusanooUnleashed (talk) 23:44, March 9, 2012 (UTC)
I know, my point being that sharingan can distinguish a clone after all. --Elveonora (talk) 23:46, March 9, 2012 (UTC)
- Because the wood clone is made of wood. Shadow clone creates a perfect copy. Omnibender - Talk - Contributions 03:20, March 10, 2012 (UTC)
And Water Clones are made of water, Lighting Clones of lighting etc. But is not Water Clone just a Shadow Clone with water element added to it ? I mean, they are solid, can use techniques and when dispelled, the remaining chakra and knowledge gained are added to the user. The clone disperse into wood on the same conditions as Shadow Clones dispel ... when hit so they lose focus to maintain their state, right ? Thus Any solid clone is a copy of the user. That's my point, Madara was able to see it's a Wood Clone with his Sharingan thus tell the fake from original. Then I don't see why it would be false for any other type of solid clone. --Elveonora (talk) 15:47, March 10, 2012 (UTC)
No. The only clones that were ever said to be Shadow Clone plus something are Lightning Release Shadow Clone (per name), the anime Earth Release Shadow Clone (anime-only technique, also per name), and Deidara's Suicide Bombing Clone (per databook description). No clone other than the Shadow Clone was ever said to send remaining chakra and acquired knowledge back to the original. The clone is made of wood made to look like the original, it's made of something else, and that difference is apparent to the Sharingan. Shadow clones are perfect copies. Omnibender - Talk - Contributions 15:52, March 10, 2012 (UTC)
Oh, right. Thought all elemental clones are enhanced shadow clones. But reading thw Wood Clone technique article it works differently ... sorry then. --Elveonora (talk) 16:07, March 10, 2012 (UTC)
Immunity to genjutsu
In chapter 260, the clone containing 30% of Itachi's chakra put Kakashi's shadow clone under an illusion: Demonic Illusion Burning Paper Body but it didn't work and Itachi says 'No wonder you aren't affected by the illusion, this is a shadow clone' doesn't this mean shadow clones are immune to genjutsu? Shouldn't it be mentioned?FlyingRaijin (talk) 19:12, March 12, 2012 (UTC)
- The shadow clone is trapped in a genjutsu, not the one who created the shadow clone. Omnibender - Talk - Contributions 22:01, March 12, 2012 (UTC)
But Kakashi's clone could still move even as it was in the genjutsu, it grabbed Itachi to keep him in place and Itachi said he wasn't affected by the genjutsu.FlyingRaijin (talk) 10:10, March 13, 2012 (UTC)
- The clone was shown being affected by the genjutsu, we saw it seeing itself as a burning paper. Omnibender - Talk - Contributions 00:14, March 14, 2012 (UTC)
"No wonder there was no reaction to the genjutsu… This is a Shadow Clone…" (「幻術に手応えが無いハズだ…これは影分身…」, "Genjutsu ni tegotae ga nai hazu da… Kore wa Kage Bunshin…")
Isn't this at least worth being in trivia?FlyingRaijin (talk) 13:51, April 12, 2012 (UTC)
Can the user summon a shadow clone far away from the real person or does he have to be near by —This unsigned comment was made by 184.108.40.206 (talk • contribs) .
- Naruto summoned clones from Mount Myōboku to Konoha using a scroll, if that answers your question. Jacce | Talk | Contributions 04:26, July 20, 2012 (UTC)
- I think the question was how far from himself he can make a clone. Probably nearby. Omnibender - Talk - Contributions 21:52, July 20, 2012 (UTC)
I believe that it is in relative close proximity to the user however this is also undermined from naruto creating 1000 clones all over the place and the ring of clones against kimmimaru so its hard to actually state if its in close proximity of the user or can be done over a distance. --Zenryoku90 (talk) 23:10, July 20, 2012 (UTC)
A question
can a bunshin use a genetic dojutsu abilities of the one who created the bunshin like trapping an enemy in genjutsu using the sharingan?--Charmanking2198 (talk) 02:56, August 14, 2012 (UTC)
- Obviously. Shadow clones are able to use all the techniques available to the original, as long as they have enough chakra to power it. Omnibender - Talk - Contributions 04:01, August 14, 2012 (UTC)
Ok , i get it.--Charmanking2198 (talk) 04:05, August 14, 2012 (UTC)
Zabuza is a user
Zabuza claimed he can use it in chapter 25 page 7. However, the scene ere he considers the thought wasn't shown in the anime in episode 14. NoJutsu (talk) 06:53, November 17, 2012 (UTC)
- That was Kakashi's thoughts. Jacce | Talk | Contributions 07:22, November 17, 2012 (UTC)
- Eeeyup. --X29 11:46, November 17, 2012 (UTC)
Madara in chapter 611 called it a forbidden ninjutsu. I thought it was called so as well, when Kakashi was giving Naruto elemental ninjutsu lessons way back. Should it be classified as such Kinjutsu as well?Umishiru (talk) 08:59, November 28, 2012 (UTC)
- Madara is talking about Multiple Shadow Clone Technique. --The Goblin 09:49, November 28, 2012 (UTC)
Users of Kage Bunshin
Naruto, Konohamaru, Jiraiya, Kakashi, and Itachi are the only real users of the Shadow Clone Jutsu. When people like Deidara amd Kakuzu male a clone, it's a clayclone or a water clone. Whoever put all those users on the list besides the one's I've mention has wrong info. No offense, but get ur facts straight —This unsigned comment was made by Kadio123 (talk • contribs) .
- lol nope, Shadow clones are a component of the Suicide Bombing Clone. also, kakuzu is not listed as a user, so what exactly is your point?? learn to get YOUR facts straight first before scolding others.126.96.36.199 (talk) 00:31, March 9, 2013 (UTC)
Shadow Clone Math
Probably a question that has been answered already, but is it really true that the shadow clone jutsu divides the user's chakara equally? Well, I know it does for Kakashi (he said it during his fight with Pain and noted it would severly drop by simply making one clone during the fight with the Jinchurikis), but is Naruto an exception? Despite how much chakara he has, it should still deplete quite quickly, don't you think? If we go by that math, Naruto should have died a long time ago lol 22.214.171.124 (talk) 00:54, April 9, 2013 (UTC)
I believe the remaining chakra of a clone returns back to the original??? Because if not, then the only explanation would be that it's possible to set up an exact amount a clone will have, instead of fifty-fifty ratio. Simply making 1 clone would eat up more chakra than 1000 0_o--Elveonora (talk) 13:48, April 9, 2013 (UTC)
Yeah, I was just thinking it might be that. Oh wait, this just came to mind. That doesn't seem to be the case for Kakashi. Actually, and this also came to mind just now lol if that were the case people could be free to use as many clones as Naruto does. If it goes back to the original then the user could just be careful about making them use chakara. Even though Naruto has a lot of chakara, if it just goes back to them when they disappear, they could do the same thing. So it must be that they could only have a certain amount of chakara per clone. It also makes sense for this to be unique to Naruto. Or maybe we are overthinking this and it is just an hole in this that we were supposed to forget? XD 18.104.22.168 (talk) 19:42, April 9, 2013 (UTC)
I know, old topic, but I'm just thinking, if the Chakra is divided equally, it wouldn't be a case where a thousand clones take less than one, because one clone would have half the chakra, so would the user. Two clones would then have 2/3 the chakra and the user would be left with a third. There's less Chakra in each one, but initiating the technique always costs more for more clones. It's a constantly dividing number which will, in theory, never reach zero, but I imagine there comes a point where the user has too little chakra to sustain their own life, such as when Kakashi died fighting Pain. In this case it makes the technique incredibly risky as using even one clone costs the user half their overall chakra, so that actually makes Kakashi a bit of a tank because he managed to make dozens of these things, even if they didn't do anything. I imagine, if a clone is dispelled, the remaining chakra might return to the user along with the experience, but perhaps if they're forcibly popped only the experience comes back, I'm not sure, but basically, even if the chakra comes back or not, even the simplest use of this move costs the user 50% of their current chakra, so for people who aren't Naruto and have massive reserves to begin with, this could be a threat to their life, where as Naruto can comfortably give up 1999/2000th of his chakra and still have plenty to spare for other techniques and keeping himself going.
To maybe illustrate this a bit better, let's call Kakashi's chakra level 10 and Naruto's 100. In this case, if they both create one Shadow clone, while Naruto's will cost a whopping 50 to Kakashi's 5, this still leaves Naruto with 50 and Kakashi with a meager 5. Say they each create four clones then, This brings Naruto down to 20, but Kakashi down to 2. Nine clones then leaves Naruto on 10 and Kakashi on 1, They're both standing on a tenth their chakra, but Kakashi is a lot closer to empty than Naruto. I know this is probably obvious, but you never know, it might help explain to those who are as confused as my friends above there and myself until I sat and thought it over. --Hawkeye2701 (talk) 01:07, July 7, 2013 (UTC)