Bortezomib in combination with cyclophosphamide and dexamethasone (CyBorD, is a well-established frontline chemotherapy regimen for patients with multiple myeloma, but prospective data on elderly non-transplant eligible patients is limited. A total of 155 patients aged 70 years or older with newly diagnosed multiple myeloma who received at least one cycle of CyBorD chemotherapy in three centres across New Zealand were evaluated. Partial response or better was achieved in 79Á4%, of whom 52Á9% achieved at least a very good partial response. After a median follow-up of 31Á9 months, the median event-free survival (EFS) was 17Á0 months (age 70-80 years, 17Á7 months; age above 80 years, 8Á6 months; P = 0Á002). The median overall survival was 45Á1 months (age 70-80, 49Á8 months; above 80, 33Á3 months; P = 0Á003). Amongst those who had seven or more cycles of treatment, those who had a pre-planned switch to bortezomib-thalidomide-dexamethasone (VTD) consolidation had a superior median EFS of 25Á4 months, compared with 20Á3 months in the CyBorD only group (P = 0Á028). This is the largest real-world dataset on the efficacy of CyBorD in the elderly population, and pre-planned switch to VTD was associated with better outcomes.

Background Our own observations suggested that placebo and nocebo effects may occur with transfusions. However these effects seem to have been poorly studied. Objectives To examine published information on, and draw attention to the possibility of, placebo and nocebo effects with transfusion. Methods Focused literature review. Results There is some information on placebo effects with clotting factors and this effect appears modest at best. There is very little published information on this regarding other fresh blood components. Although unknown biologic effects cannot be ruled out, there are hints that placebo effects might operate ‐ especially with red blood cell transfusions. There is practically no information on nocebo effects with transfusions. Conclusions There are ways of surmounting the practical and ethical difficulties involved, and obtaining better information on both types of effects. Individualised, contextualised, informed consenting of transfusion recipients may help to enhance placebo, and reduce nocebo, effects. This may be supportable ethically, and desirable clinically, and financially.

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