For these people, the standard of care has been chemotherapy with melphalan and prednisone. Recent studies among this population suggest improved outcomes with new chemotherapy regimens, e.g., with bortezomib. Treatment with bortezomib, melphalan, and prednisone had an estimated overall survival of 83% at 30 months, lenalidomide plus low-dose dexamethasone an 82% survival at 2 years, and melphalan, prednisone, and lenalidomide had a 90% survival at 2 years. Head-to-head studies comparing these regimens have not been performed as of 2008.There is support for continuous therapies with multiple drug combinations of antimyeloma drugs bortezomib, lenalidomide and thalidomide as initial treatment for transplant-ineligible multiple myeloma. Further clinical studies are required to determine the potential harms of these drugs and the effect on the persons quality of life. A 2009 review noted, "Deep venous thrombosis and pulmonary embolism are the major side effects of
thalidomide and lenalidomide. Lenalidomide causes more myelosuppression, and thalidomide causes more sedation. Chemotherapy-induced peripheral neuropathy and thrombocytopenia are major side effects of bortezomib. "Treatment of related hyperviscosity syndrome may be required to prevent neurologic symptoms or kidney failure. Maintenance
Most people, including those treated with ASCT, relapse after initial treatment. Maintenance therapy using a prolonged course of low-toxicity medications is often used to prevent relapse. A 2017 meta-analysis showed that post-ASCT maintenance therapy with lenalidomide improved progression-free survival and overall survival in people at standard risk. A 2012 clinical trial showed that people with intermediate- and high-risk disease benefit from a bortezomib-based maintenance regimen.
In this they were the reverse of the Renaissance intermezzo, which usually had a mythological or pastoral subject as a contrast to a main comic play. Often they were of a burlesque nature, and characterized by slapstick comedy, disguises, dialect, and ribaldry. The most famous of all intermezzi from the period is Pergolesis La serva padrona, which was an opera buffa that after the death of Pergolesi kicked off the Querelle des Bouffons. In some cases the intermezzo repertory spread more quickly than did the opera seria itself; the singers were often renowned, the comic effects were popular, and intermezzi were relatively easy to produce and stage. In the 1730s the style spread around Europe, and some cities—for example Moscow—recorded visits and performances by troupes performing intermezzi years before any actual opera seria were done. The intermède (the French equivalent of the intermezzo) was the single most important outside operatic influence in Paris in the mid-18th century, and helped create an entire new repertory of opera in France (see opéra comique). The word was used (with a hint of irony) as the title of Richard Strausss two-act opera, Intermezzo (1924), the scale of which far exceeds the intermezzo of tradition. Many of the most celebrated intermezzi are from operas of the verismo period: Mascagnis Cavalleria rusticana and Lamico Fritz, Leoncavallos Pagliacci, Puccinis Manon Lescaut and Suor Angelica, Giordanos Fedora, Cileas Adriana Lecouvreur, and especially that from Massenets Thais, which became known as the Méditation.